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									Mayor's Mental Health Task Force Final Report
Fittest City in America Initiative Austin, Texas

January 2005

Morningside
R e s e a r c h A N D
C o n s u l t i n G, I n c

w w w. m o r n i n g s i d e r e s e a r c h . c o m

Mayor’s Mental Health Task Force Final Report
Fittest City in America Initiative Austin, Texas

January 2005

Prepared by Morningside Research and Consulting, Inc. P.O. Box 4173 Austin, Texas 78765 Phone 512 302 4413 • Fax 512 302 4416 www.morningsideresearch.com and

Angela Luck & Rachel Howell www.copiaconsulting.com 512.462.1137

THE MAYOR’S MENTAL HEALTH TASK FORCE

T able of Contents
Executive Summary.............................. i Mental Health in Austin and Travis County.................................................. 1 Prevalence .........................................................1 Funding ..............................................................5 Purpose ................................................ 8 Statement of Purpose ........................................8 Goals..................................................................8 Process ................................................ 9 Assessment of Austin and Travis County................................................ 10 Different Vantage Points ..................................10 System Strengths.............................................10 Challenges and Gaps ......................................12 Criteria for a Healthy Community...... 16 Criteria by Category .........................................16 Findings and Recommendations ....... 22 Action Plan ........................................ 25 Immediate ........................................................25 Short-term (2 years).........................................26 Long-term (3-6 years) ......................................28 Appendix A: Subcommittee Reports 31 Justice Systems Subcommittee..... 32 The Past ....................................................... 32 The Present .................................................. 32 The Future .................................................... 36 Criteria for a Mentally Healthy Community ... 37 Short- and Long-Term Treatment Subcommittee................................. 39 The Past ....................................................... 39 The Present .................................................. 40 The Future .................................................... 44 Criteria for a Mentally Healthy Community ... 45 Housing Subcommittee................... 48 The Past ....................................................... 48 The Present .................................................. 49 The Future .................................................... 51 Criteria for a Mentally Healthy Community ... 52 Education and Community Awareness Subcommittee.............. 54 The Past ....................................................... 54 The Present .................................................. 55 The Future .................................................... 59 Criteria for a Mentally Healthy Community ... 60 Appendix B: Participants................... 62 Appendix C: Action Plan Detail ........ 65

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Executive Summary
Background The Mayor’s Mental Health Task Force is the culmination of several years of community concern over the challenges faced by residents with severe mental illnesses. City of Austin Mayor Will Wynn created the Mayor’s Mental Health Task Force in August of 2004. More than 80 individuals representing over 40 organizations participated over a period of five months to 1) identify the strengths and gaps in mental health services in the community, 2) develop criteria that define a mentally healthy community, and 3) create an action plan to close the gaps in the community. Strengths and Challenges The Task Force participants identify both a number of strengths and a number of gaps and challenges in mental health services in the community.
Infrastructure: The primary strength is the sheer number of agencies and organizations involved in the

provision of mental health services and supports as well as the education and knowledge levels of the community and its leaders. The concern, involvement, and commitment of community leaders, policymakers, mental health service providers, and professionals in the justice system are great assets to the community. The involvement of consumers and families is also strong. While the number of organizations involved in the mental health arena is extensive and participants cite evidence of cooperation and collaboration among agencies, the mental health system is characterized by fragmentation. Coordination of services is not always effective and consumers often have difficulty navigating the system as a result. Opportunities are clearly available to enhance the relationships between organizations to increase coordination, communication, and collaboration. The community has a varied and flexible array of housing, but an insufficient supply to meet the needs of people with mental illnesses. More housing that is affordable for people at very low income levels is needed. Hospital-based psychiatric emergency and inpatient services are also identified as insufficient to meet demand.
Policies: At the policy level, mental health issues compete for time and attention with other pressing

concerns. Specific policy issues raised by the subcommittees include privacy issues that pose barriers to data sharing among agencies and the lack of parity in insurance coverage between mental health and physical health. Regulations and practices that keep people out of housing, such as credit history or criminal history screens, have a particularly negative impact on individuals with mental illness. An ongoing challenge is how to balance the need for oversight and accountability with the desire for flexibility in decision-making by service providers and professionals in the justice system. The implementation of HB 2292 by the Texas legislature is considered by participants to be problematic. The legislation limits the adult priority population that can be served by local mental health authorities,
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prescribes the use of a disease management approach to treatment, and eliminates certain mental health services, such as counseling, for adults in the Medicaid program, among many other provisions.
Training: A number of existing training programs are praised by participants, but more training is

needed. Several specific training needs are identified for various audiences, including consumers, providers, and professionals.
Resources: Mental health resources are made available by state and local governments, businesses,

foundations, and private entities. Local decision-makers are seen as supportive of funding for the Austin Travis County Mental Health Mental Retardation Center and of investing in affordable housing. Every subcommittee, however, indicated that there is a severe lack of resources for mental health services. Specific challenges include the recent cuts in Medicaid-covered mental health services for adults, the high cost of medications, the lack of resources for more diversion options, the need for funding to rehabilitate existing housing stock, the need for funding to provide rental assistance, the need for funding to promote healthy behaviors and early detection and intervention, the need for coordination and collaboration between publicly supported organizations and private resources, the need for more volunteer resources, and an inability to adequately serve the indigent and the uninsured populations.
Attitudes: Strengths include the willingness, compassion, and commitment of the community and local

leaders. The Austin community is seen as progressive, concerned, and proactive and has a high level of awareness of the need for mental health services. The community also values diversity and recognizes the need for culturally- and linguistically-appropriate services. One of the biggest challenges, however, is that the stigma of mental illness persists. Participants believe that media publicity about mental health is primarily negative and there is an opportunity to improve the frequency and quality of public service announcements about mental health. In particular, the public needs to understand that mental illness is treatable and that recovery is possible. In the area of housing, there is a “not in my backyard” (NIMBY) attitude. Additionally, consumers facing stigma may avoid selfadvocacy and fear speaking up about their mental health needs. Although consumers can live successfully and productively in recovery, it can be difficult to communicate hope for recovery to those experiencing mental illness.
Programs: The Austin community has many existing programs that provide essential and, in some

cases, innovative mental health services, but the scope of many current services needs to be expanded and many additional services are needed. One of the most pressing issues raised by each of the subcommittees is the difficulty consumers face accessing mental health services, with timeliness being especially critical. Although many consumers receive medication through the Austin Travis County Mental Health Mental Retardation Center, eligibility guidelines and the high cost of medication make access to medications difficult for some consumers. Recent state legislation has further impacted access by limiting the adult population that can be served by local mental health authorities and eliminating most mental health counseling services for adults in the Medicaid program. The community has excellent consumer involvement. Strong advocacy groups and a growing number of consumer and family support groups exist in the community. The involvement of the faith community in providing services and support is important and could be expanded and improved.

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Participants believe that more quantitative data and more consistent collection of standardized data about programs are needed, including indicators that measure program effectiveness and impact. Inadequate resources prevent the collection and analysis of data. Criteria for a Mentally Healthy Community Participants have addressed the challenges and gaps by creating 39 criteria that, when achieved, will define Austin as a mentally healthy community. The criteria are grouped into the following five categories.
Infrastructure: This category includes infrastructure that is needed to create additional physical capacity

in the community, including psychiatric emergency service beds, detox beds, residential treatment options, housing units, and data systems for housing services. Two groups, the Justice Systems subcommittee and the Short- and Long-Term Treatment subcommittee, both had the creation of psychiatric emergency service beds in one or more local hospitals as their number one priority. Along with the Programs criteria below, these criteria are likely to be the most costly to implement, but will provide a more complete array of physical infrastructure than currently exists.
Marketing: Participants suggest the creation of several marketing campaigns to provide mental health

education and awareness information to the entire community as well as to some specific audiences. The community needs to know that mental illness is a curable and treatable disease and that appropriate treatment can mitigate negative effects and even cure mental illness. This element is viewed by many members of the Education and Community Awareness subcommittee to be the foundation of all the other recommendations. Without a strong awareness campaign that replaces the stigma of mental illness with positive images of treatment and recovery, and without a great deal of public education regarding the continuum of mental health to mental illness, participants fear that other changes and improvements will stall based on a lack of understanding and knowledge.
Policies and plans: Several policies and plans seek to develop community standards and guidelines for

funding and delivery of mental health programs. These policies and plans include a coordinated funding plan, standards of care based on culturally competent best practices, a city-wide housing plan, a policy of parity for mental and physical health insurance coverage, a suicide prevention plan, and an informationsharing policy. When implemented, these policies and plans will more clearly define the mental health “system” and make it more identifiable to funders, consumers, and the community.
Programs: These criteria include new or expanded programs to address specific areas of concern. They

include outpatient services available within one week of identified need; access to routine, urgent, and emergency care; supportive case management; a pre-booking system; diversion programs; a post-booking mental health and mental retardation docket; and an elementary through secondary school program focused on mental health. Along with the Infrastructure criteria, some of these criteria may be costly to implement, but when implemented, they will provide a more comprehensive continuum of services that creates a more effective mental health services delivery system and ultimately reduces the cost of addressing long-neglected mental health problems.
Training and education: These criteria include the development of curriculum-based education and training programs on specific topics such as appropriate crisis intervention with individuals with mental illness; housing laws and rights; local, state, and federal laws and responsibilities; promoting hope, recovery, and self-determination; and accessing funds to build, own, or modify housing. The training also
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targets mental health education to a variety of specific audiences, including professionals in law enforcement and the justice system, policymakers, consumers and families, students in elementary school through college, housing developers, lenders, landlords, and the faith-based community. Action Plan A sense of urgency is evident in the action planning undertaken by the subcommittees. More than half of the 39 criteria identified in the subcommittees have been given a completion date within the next two years. The remainder of the criteria will be accomplished within six years. The detailed action plan with tasks and responsible parties is included in the Action Plan section of this report beginning on page 25. Implementation of the action plan requires considerable further commitment from the organizations that participated in the Task Force. Because organizations and individuals are identified as participating in multiple tasks in each of the 39 criteria over the next seven years, the action plan, as developed, will be a very ambitious undertaking.
Monitoring Committee: A subcommittee of the Austin Travis County Mental Health Mental

Retardation Center Board of Directors will serve as the Monitoring Committee for the Mayor’s Mental Health Task Force. The Monitoring Committee will take a lead role in monitoring and facilitating the implementation of Task Force criteria and coordinating the assistance of existing groups and organizations in that effort. The Monitoring Committee will serve for a five-year period of time and will report to the Mayor annually. Findings and Recommendations
More than funding: While funding for mental health services can be scarce, a lack of funding is not

solely responsible for perceived shortfalls or challenges in the provision of mental health services within the Austin/Travis County area. Considerable opportunities have been presented by the Task Force to educate stakeholders about the structure and function of the mental health service delivery system and to enhance, strengthen, and redefine the system to gain efficiencies. There are several excellent criteria for strengthening policies and plans related to the delivery of mental health services that should be implemented. These criteria address the need to standardize operations and to formalize planning and will assist in creating a more unified system. In addition, the marketing and training criteria should be implemented to develop directed campaigns to educate all stakeholders.
Parallel efforts: A number of other mental health initiatives are under way in the community and the

action plan developed by the Mayor’s Mental Health Task Force must be coordinated with these existing initiatives. One entity should be responsible for coordinating and supporting mental health planning initiatives and funding proposals within the community.
Coordinated planning and funding: Local mental health budget requests should be consistent with

the policies and plans proposed in the Task Force criteria. Once developed, the plans and policies proposed by the Task Force should be adopted by local governing bodies and related boards and commissions to allow all planning and funding proposals submitted to these bodies to be compared to the adopted policies and plans for alignment and consistency.

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Continuation of efforts: Task Force participants are very motivated by the process they have been through and want to maintain their momentum around mental health issues. To facilitate the process of implementation, the Planning Committee should finalize the membership and role of the Task Force Monitoring Committee and form working groups to begin implementation of the action plan. Cultural relevancy: The effort that was undertaken by the Task Force focused on the mental health needs of the entire Austin/Travis County population. While the need for culturally- and linguisticallyappropriate services is identified in several criteria, demographic information about service recipients and the specific mental health needs of various racial and ethnic groups were not fully explored. Additional work is needed to report the demographics of consumers, to identify existing programs that serve racial and ethnic minorities, and to specify the current and future mental health needs of various racial and ethnic groups. Additional work on Marketing and Training criteria: Within the Marketing and Training

categories, additional synthesis of the multiple criteria is needed to more clearly identify the gaps and develop an action plan that does not duplicate existing efforts. Each of the working groups established to implement the action plan in the Marketing and Training categories should separately develop a resource matrix for their category that will more clearly identify the gaps and resource needs.
Best practices and evaluation: Participants suggest that too few mental health programs are based

on evidence-based best practices. More quantitative data and more consistent data about programs are needed, including indicators that measure program effectiveness and impact. Each of the five working groups formed to implement the action plan should engage in a process of identifying current best practices in other communities to guide and inform their planning. Each working group should include in their action plans a process for evaluating the effectiveness of the criteria that are implemented.
Measuring a mentally healthy community: No communities have been identified that are known

to be measuring mental health beyond the common use of suicide rates and substance abuse-related measures. The mental health oversight committee should work toward the development of a “mental health dashboard” to measure the progress and impact of the criteria that have been developed. This “dashboard” would include measures that define a healthy community and give information on both process and outcomes, such as the number of people living in recovery, the number of people served, and the number of people on waiting lists for various services.

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Mental Health in Austin and Travis County
Prevalence
The prevalence of mental disorders constitutes a serious health risk that affects a high proportion of the population. Major depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder comprise four of the ten leading causes of disability across the world and in the United States.1 While the prevalence of specific mental disorders may vary based on demographics, all ages, racial and ethnic groups, genders, and socioeconomic groups are subject to their effects. In fact, approximately 19 percent of the American population aged 18 to 64 will experience some diagnosable mental disorder, excluding substance abuse disorders, during their lifetime.2 The U.S. Department of Health and Human Services estimates that only about 47.3 percent of those with mental disorders obtain treatment.3 Some populations are more vulnerable to mental illness than others. While overall prevalence statistics for mental illness may appear similar across ethnic groups, these statistics may not fully take into account those who are homeless, incarcerated, or institutionalized. For example, there is an overrepresentation of people with mental illness in U.S. prison systems. According to the Texas Criminal Justice Policy Council, in FY 2001 approximately 17 percent of offenders on probation or parole had a history of contact with Texas’ mental health system. Comparatively, only approximately 8 percent of those offenders received mental health services through the justice system.4 The U.S. Department of Justice estimates that about 16 percent of those in prison or jail have a mental illness.5 In terms of juvenile offenders, prevalence rates point to more extensive mental health issues. The Office of Juvenile Justice and Delinquency Prevention reports that up to 60 percent of juveniles in the justice system have a diagnosable mental health disorder.6 In fact, in 2002, the Texas Youth Commission reported that approximately half of its population had been diagnosed with a serious

1 2

National Institute of Mental Health. The Numbers Count: Mental Disorders in America, 2001. http://www.nimh.nih.gov/publicat/numbers.cfm.

Regier, D.A.; Narrow, W.; and Rae, D.S. Unpublished National Institute of Mental Health (NIMH) analyses, 1999. Regier, D.A.; Narrow, W.; Rae, D.S.; et al. “The de facto U.S. mental and addictive disorders service system. Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services.” Archives of General Psychiatry 50:85-94, 1993. PubMed; PMID 8427558. Kessler, R.C.; McGonagle, K.A.; Zhao, S.; et al. “Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the U.S.” Archives of General Psychiatry 51:8-19, 1994. PubMed; PMID 8279933. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. National Survey on Drug Abuse: Volume I. Summary of National Findings; Prevalence and Treatment of Mental Health Problems, 2003. http://oas.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#8.2[1][1]

3

4

Texas Criminal Justice Policy Council. Overview of the Enhanced Mental Health Services Initiative, 2002. http://www.cjpc.state.tx.us/reports/mental/mhoverview.pdf

5 Ditton, Paula.M. Mental Health Treatment of Inmates and Probationers, Washington DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, July 1999. 6

Cocozza, J.J. and Skowyra, K. “Youth with Mental Health Disorders: Issues and Emerging Responses.” Juvenile Justice, VII, 1, 2000.
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mental illness.7 Minority populations may also be overrepresented in these vulnerable groups that tend to have higher rates of mental disorders.8 Approximately one in five Texas adults (over 3 million people) has a mental illness. As seen in Figure 1, percentages of the population needing and receiving mental health services across the state are reflected in Travis County. In Travis County alone (adult population 666,606), 2004 estimates indicate that there are over 130,000 adults with mental illness. 9 Of these, only 22,230 fall into the priority population served by the Austin Travis County Mental Health Mental Retardation Center (ATCMHMR). The priority population eligible for adult mental health services, as defined by the Texas Department of State Health Services, consists of adults who “have severe and persistent mental illnesses such as schizophrenia, major depression, bipolar disorder, or other severely disabling mental disorders which require crisis resolution or on-going and long-term support and treatment.”10 Only about one-third of the priority population is receiving services. Recent state legislation targets state funding for intensive and on-going services to treat three mental illnesses -- bipolar disorder, schizophrenia, or severe clinical depression -- using a disease management approach. Crisis intervention is provided to all individuals.11 TDMHMR estimates that by 2007, the priority population in Texas will have increased to 431,962, a seven percent increase. 12

7 8

Texas Youth Commission. Who are TYC Offenders? http://www.tyc.state.tx.us/research/youth_stats.html

Koegel, P., Bumam, M., Audrey, F., and Rodger, K. “The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles,” Archives of General Psychiatry, 45, 1085-1092, 1988. Teplin, Linda A. “Detecting disorder: The treatment of mental illness among jail detainees,” Journal of Consulting & Clinical Psychology, 58, 233-236, 1990
9

Texas Department of State Health Services. 2001-2005 Adult Mental Health Prevalence/Priority Population Data. http://www.dshs.state.tx.us/mhreports/01-05RevisedMHAdultPre-PriPopData.pdf Health and Human Services Commission. Texas Health and Human Services System Strategic Plan for FY 2005-2009, Chapter IX: Department of State Health Services, July 2004. http://www.hhsc.state.tx.us/StrategicPlans/HHS05-09/HHS_StPlan_rv.html Texas Health and Safety Code § 533.0354(a).

10 Texas 11 12

Texas Department of State Health Services. 2001-2005 Adult Mental Health Prevalence/Priority Population Data. http://www.dshs.state.tx.us/mhreports/01-05RevisedMHAdultPre-PriPopData.pdf
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Figure 1 Prevalence of Mental Illness in Texas Adults 2004
Texas Adults with Mental Illness N=3,156,288 Priority Population (19.6%) Travis County Adults with Mental Illness N=130,811 Priority Population (19.6%) N=22,230
17% of Adults with Mental Illness

N=441,195 14% of Adults with Mental Illness

Served by MHMR N=107,558 24.4% of Priority Population 3.4% of Adults with Mental Illness

Served by MHMR N=7,121 32% of Priority Population 5.4% of Adults with Mental Illness

Note: This data excludes NorthSTAR Behavioral Health Program, a multi-agency capitated managed care program in north Texas.

As compared to adults, a slightly smaller percentage of children in Texas (the total child population is approximately 6 million) have been classified as having a mental illness (208,677). However, a smaller percentage of the child priority population is being served. There are nearly 42,000 children estimated to have or be at risk of having mental health problems in Travis County in 2004, of which 24,000 are estimated to have a serious emotional disturbance. Only about 5,000 children fall into the priority population that can be served by ATCMHMR. The priority population eligible for children’s mental health services, as defined by the Texas Department of State Health Services, consists of children and adolescents ages 3 through 17 years with a diagnosis of mental illness who exhibit serious emotional, behavioral, or mental disorders and who have a serious functional impairment. 13 Recent state legislation targets state funding for children with “serious emotional illnesses.”14 As seen in Figure 2, while Travis County has a higher percentage of priority population children served by MHMR than Texas overall, the percentage remains small. 15

13 Texas Health and Human Services Commission. Texas Health and Human Services System Strategic Plan for FY 2005-2009, Chapter IX: Department of State Health Services, July 2004. http://www.hhsc.state.tx.us/StrategicPlans/HHS05-09/HHS_StPlan_rv.html. 14 15

Texas Health and Safety Code § 533.0354(a).

Texas Department of State Health Services. 2001-2005 Child Mental Health Prevalence/Priority Population Data. http://www.dshs.state.tx.us/mhreports/01-05RevisedMHChildPre-PriPopData.pdf
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Figure 2 Prevalence of Mental Illness in Texas Children 2004
Texas Children with SED N=718,263 (12%)
Priority Population N=152,174 2.1% of Children with SED

Travis County Children with SED Priority Population N=5,217 N=24,624 2.1% of Children with SED (11%)

Served by MHMR N=22,499 14.8% of Priority Population 3.1% of Children with SED

Served by MHMR N=1,298 24.9% of Priority Population 5.3% of Children with SED

Note: This data excludes NorthSTAR Behavioral Health Program, a multi-agency capitated managed care program in north Texas.

Suicide Rates per 100,000
15 14 13 12 11 10 9 8 7 6 5 13.9 13.3 11.0 13.6

Texas Travis County
1994 1996 1998 2000 2002

Related indictors of mental health can help to illuminate the importance of mental health services. For example, suicide is most commonly associated with depression, and 90 percent of the suicides carried out are related to untreated or under-treated mental illness. 16 Concurrent substance use further increases the risk. In 2002, there was an average of 6 deaths per day by suicide in Texas; this is 1.5 times more suicides than homicides. The suicide rate of 13.6 per 100,000 people in Travis County is higher than Bexar County (9.6), Dallas County (10.7), El Paso County (8.3), Harris County (11.6), as well as the Texas average (11.0). 17

16

Mental Health Association in Texas. “Fact Sheet on Suicide in Texas,” Revised June 7, 2004. http://www.mhatexas.org/D_TXToolkit4_pg97.pg119.pdf Texas Department of State Health Services. Texas Health Data, Death of Texas Residents. http://soupfin.tdh.state.tx.us/death10.htm
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Substance-Related Death Rates per 100,000 70 65 60 55 50 45 40 35 30 25 20 65.8 62.4 52.7 67.4

Travis County Texas

Similarly, substance-related deaths are indicative of the need for mental health services. In Texas there was an average of 40 substance-related deaths a day during 2002. In Travis County alone there was a yearly average slightly higher than one a day. In 2002, Texas had an overall substance-related death rate of 67.4 for 2002, while Travis County had a rate of 52.7.18

State and local figures on the prevalence of mental disorders and the broad need for mental health services show clearly that many children and adults are not receiving treatment for their identified mental disorders. One of the reasons for this situation is that scarce funding prohibits broader mental health service provision.

1995

1998

2000

2002

Funding
In fiscal year 2001, the state of Texas ranked 46th in annual per capita spending ($37.53) on mental health. However, Texas ranked 5th in the nation for total expenditures on mental health services ($796,974,433). Texas also ranked 5th in the nation for expenditures on state psychiatric hospitals, 7th in community-based programs, 2nd in prevention, research, and training and 10th in administrative costs.19 The total spending for behavioral health services by the Austin Travis County Mental Health Mental Retardation Center (ATCMHMR) for FY 2004 was $15,286,208, which was 43 percent of the total ATCMHMR annual budget ($35,458,923). Of the behavioral health services budget, 27 percent came from local sources, 28 percent from the state of Texas, and 45 percent from the federal government.20 ATCMHMR also has an allocation of bed days at the Austin State Hospital equal to $6,819,434. This amount is set aside in a trust fund for use by ATCMHMR according to a formula for calculating the cost of bed-days developed by the Texas Department of State Health Services. In addition to ATCMHMR, several other agencies also provide mental health services in the community. The table on the following page shows the agencies and their current budget for mental health services.

18 19

Ibid.

National Association of State Mental Health Program Directors Research Institute, Inc. “Funding Sources and Expenditures of State Mental Health Agencies: Fiscal Year 2001.” http://www.nri-inc.org/revexpreport.cfm
20

Austin Travis County Mental Health Mental Retardation Center. Fiscal Year 2005 Budget.
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Mental Health Funding in Austin/Travis County
Organization Advocacy Inc. Arc of the Capital Area* Austin Men’s Center Austin Child Guidance Center Austin Children’s Shelter Austin Travis County Mental Health Mental Retardation Center Capital Area Mental Health Association Catholic Charities Children’s Mental Health Partnership Communities in Schools-Central Texas, Inc. Easter Seals * E-Merge Helping Hand Home for Children LifeWorks Lutheran Social Services SafePlace St. David's Pavilion Hospital Salvation Army Samaritan Counseling Center Seton Shoal Creek Hospital Settlement Home Simms Foundation Travis County Adult Probation Department Travis County Juvenile Probation Department Out Youth Austin United Way Capital Area-First Call for Help Waterloo Counseling Center Youth and Family Assessment Center YWCA of Greater Austin Current Annual Budget for Mental Health Services and Supports $2,000,000 $86,132 $100,000 $1,190,355 Information Not Yet Available $15,286,208 $150,000 Information Not Yet Available $700,500 $2,600,000 $423,651 $182,500 $3,200,000 $1,300,000 Information Not Yet Available $529,743 $4,500,000 Information Not Yet Available $800,000 $10,600,000 $3,500,000 $400,000 Information Not Yet Available Information Not Yet Available $72,300 Information Not Yet Available $330,000 $605,000 $500,000

*Amount shown is the current City of Austin and Travis County Social Service contract amount. All other budget information is from staff at each agency.

Medicaid funds paid for half of all state and locally administered mental health services in 2000, up from about one third in 1985. Although Medicaid enrollment in Travis County has increased from 61,487 in May of 2003 to 69,919 in May of 2004 (an increase of 14 percent), 3,000 Travis County adults who had previously been accessing mental health services under their Medicaid coverage lost access to those services after last fall’s state budget cuts.21 In addition to no longer providing coverage for services provided by counselors, therapists, psychologists, and social workers, Texas Medicaid does not cover employment and housing services, peer counseling or drop-in centers, and a number of other services that
Community Action Network. Community Overview, July 2004.
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are considered significant elements in the provision of comprehensive care for people with severe mental illnesses. 22 While funding for mental health services can be scarce, a lack of funding is not solely responsible for perceived shortfalls or challenges in the provision of mental health services within the Austin/Travis County area. The Mayor’s Mental Health Task Force was created by City of Austin Mayor Will Wynn to consider how the delivery of mental health services can be improved in order to promote a healthier community. As discussed in the following pages, the Task Force has identified considerable opportunities and suggested processes to enhance, strengthen, and redefine the mental health service delivery system.

22 Texas Department of State Health Services. Agency Strategic Plan for the Fiscal Years of 2003-2007. http://www.dshs.state.tx.us/mhreports/SP03-07final.pdf

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Purpose
The Mayor’s Mental Health Task Force is the culmination of several years of community concern over the challenges faced by residents with severe mental illnesses. On October 15, 2003, the Hogg Foundation for Mental Health convened a “Community Forum on Persons with Mental Illness” that was attended by thirty consumers, advocates, and community leaders. Discussions subsequent to the forum led to Mayor Wynn’s decision to create a Mental Health Task Force to address issues and to plan for improvements in the provision of services for individuals with mental disabilities. The following statement of purpose and the goals below were developed by the Mayor’s Mental Health Task Force Planning Committee.

Statement of Purpose
In recent years, residents of Austin/Travis County have become painfully aware of the challenges faced by people with severe mental illnesses in our community. Will Wynn, the Mayor of Austin, has developed a Fittest City in America Initiative designed to promote action furthering greater physical health. The Mayor is now expanding that initiative to include mental health, in recognition of the fact that mental health is a fundamental requirement for the healthy city envisioned. To address the urgent need to minimize the fragmentation and gaps in mental health care for children and adults, ensure that residents with serious mental illnesses receive the services and support they need, and reduce the burden of chronic mental health conditions, the Mayor has created a Mental Health Task Force. The Mental Health Task Force is charged with examining the mental health of the Austin/Travis County community, with a particular emphasis on four critical areas: (1) education and community awareness, (2) criminal justice [changed by the subcommittee to justice systems], (3) housing, and (4) short- and longterm treatment. After identifying mental health needs, as well as gaps and sources of fragmentation in mental health services, the Task Force will delineate a set of criteria to measure the characteristics of a mentally healthy community and will recommend actions necessary to transform Austin’s system of mental health care so that this community becomes a mentally healthy place for all.

Goals
The Mental Health Task Force will aim to: 1. Identify the criteria that define a mentally healthy community, including infrastructure, resources, policies, programs, training, and attitudes. 2. Measure the status of each criterion in Austin/Travis County. 3. Develop an action plan to become a more mentally healthy community by building on Austin/Travis County’s strengths and addressing any weaknesses.
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Process
More than 80 individuals in the Austin community representing over 40 organizations were invited to participate in four Task Force subcommittees addressing mental health issues in the justice system, shortand long-term treatment, housing, and education and community awareness. The names of participants can be found in Appendix B. Former State Representative Wilhelmina Delco and former Mayor Gus Garcia co-chaired the Task Force. The Task Force Planning Committee is composed of representatives from the City of Austin, the Hogg Foundation for Mental Health, and the Austin Travis County Mental Health Mental Retardation Center, who provided overall guidance and problem-solving assistance for the process. Each of the subcommittees met seven times from August 2004 to December 2004 in meetings lasting 2.5 to 3 hours. The participants engaged in a rigorous process to move from identifying gaps in the community to developing an action plan for closing those gaps. They were facilitated in this effort by Angela Luck and Rachel Howell of Copia Consulting. The charge to the subcommittees was to do the following: 1. Assess current service levels. 2. Develop a profile of what a mentally healthy community looks like. 3. Assess what the Austin/Travis County community is doing well. 4. Identify where there are gaps. 5. Develop an action plan with three time frames: short-term, 2-3 years, and long-term. In addition to the subcommittee meetings, the full Task Force met five times. The first meeting was the kick-off meeting, introducing the initiative and permitting the subcommittees to discuss logistics. The second and third meetings allowed the subcommittees to hear short presentations and ask questions of each other. The fourth meeting provided the subcommittee members the opportunity to review each other’s work and prioritize the criteria across the subcommittees. The final report was presented at the fifth and final full Task Force meeting. Public input was gained through an open meeting held the evening of September 28, 2004, at the Connolly-Guerrero Senior Activity Center. More than 50 people attended and provided comments and suggestions for the improvement of mental health services in Austin and Travis County. The public was also invited to attend the regular meetings of the Task Force and its subcommittees.

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Assessment of Austin and Travis County
Different Vantage Points
Task Force participants include policymakers and decisionmakers, front-line staff working more directly with consumers, advocates, and consumers. Because all levels of staff and representatives from organizations with varying missions participated together in the subcommittees, many different viewpoints were raised during discussions. All of the viewpoints expressed are included in this report, which results in seeming contradictions in some areas. For example, collaboration and coordination between agencies shows up as both a strength and a gap. The mental health system can look very different from different vantage points (the Indian parable of the six blind men and the elephant comes to mind). In some cases, the contradictions are simply a matter of degree – a particular service may be listed as a strength, for example, but the current scope of the service is insufficient for meeting the need that exists, so the service is also listed as a gap. Regardless of whether the views and perceptions expressed are considered accurate by those with different knowledge, the perceptions are real for the individuals who expressed them. The value of this information is in understanding that there is not always consensus, or “one voice” as one subcommittee put it, around each of the issues that were raised in the course of the subcommittee deliberations. Considerable effort is needed to define, strengthen, and enhance the mental health delivery system and to communicate to all stakeholders what that system looks like and how it works. The following is a summary of the strengths and challenges identified by the four subcommittees. More detail about the strengths and gaps can be found in the individual subcommittee sections of this report contained in Appendix A.

System Strengths
Infrastructure: In this category, the strengths cited by the subcommittees include the vast array of

organizations and entities that exist to provide mental health services as well as the relationships between those organizations. Organizations and entities. Austin has a wealth of committed, concerned people (community leaders, government officials, elected officials, and the general public) who are educated and knowledgeable about mental health issues as well as numerous agencies and organizations that provide mental health services, support, education, and advocacy. A tremendous amount of talent and education exists within the professional community and strong research and educational institutions are located in this community. The recent creation of the county-wide hospital district is a significant asset for the region and presents an opportunity to enhance mental health services. The subcommittees identify specific organizations they consider to be assets to the community and those organizations are listed in the individual subcommittee sections of this report.

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Regarding housing infrastructure, participants believe that Austin has a greater variety of housing in better locations relative to other communities. Austin has improved the variety and flexibility of housing that is available, with housing options including single room occupancy (SRO) units, co-operatives, rental units, and home ownership. Communication and coordination. Many participants believe that good relationships and collaborations exist among the organizations providing mental health services as well as between agencies, providers, and consumers. These “communities of interest” in health and human services are willing to work together and have a tradition of partnering to achieve goals. Many participants note that opportunities exist to improve communication and collaboration among agencies and a few participants are especially critical of what they perceive to be a lack of coordination within the community.
Resources: Although resources are considered to be a great need in the area of mental health services,

participants acknowledge that state and local governments, local businesses, private organizations, and foundations are willing to invest in the community. In addition, local decisionmakers are supportive of investments in the Austin Travis County Mental Health Mental Retardation Center and in affordable housing.
Attitudes: While the stigma of mental illness persists, positive attitudes do exist within the community,

including compassion, tolerance, and the willingness to revamp. Austin is a concerned, progressive, proactive community and has the capacity to make changes and improvements. The community and its leaders are aware of the need for mental health services and understand mental health issues. Professionals and the community place an emphasis on eradicating stigma. In addition, the community is beginning to understand and accept that individuals with mental illness can and do live in recovery. The community also values multi-cultural diversity. According to participants in the Housing subcommittee, the community is more aware and more supportive of affordable housing in Austin relative to other communities. The Austin Travis County Mental Health Mental Retardation Center has a commitment to making housing a priority and the community has a strong commitment to serve individuals who are homeless or in transition. Although media coverage of mental health issues is considered to be primarily negative, some positive media exposure does occur, at least in part because the Austin Travis County Mental Health Mental Retardation Center values public relations and works in partnership with other organizations to eradicate the stigma of mental illness.
Programs: Many specific programs are cited by the subcommittees as providing essential and, in some

cases, innovative mental health services in the community. These programs include outreach to landlords to encourage the acceptance of Section 8 vouchers to serve more individuals with mental illness, the Crisis Intervention Team,* the E-Merge program’s integration of behavioral health providers into the Austin* The Crisis Intervention Team (CIT) is a joint program of the Austin Police Department (APD) and the Travis County Sheriff’s Office (TCSO). The CIT is charged with responding to calls involving people with mental illness, following up with mental health consumers after their initial contact with law enforcement through phone calls and home visits, transporting patients to mental health facilities across the state, and training officers locally and across the state. The CIT is housed at the Austin State Hospital and is staffed by 9 full-time sheriff’s deputies and 6 full-time APD officers. An additional 150 APD officers are designated as mental health officers. Each of these officers receives 40 hours of CIT Training (basic mental health peace officer certification). All TCSO deputies

Footnotes continued on the next page.

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Travis County Community Health Centers’ primary care practice, and the involvement of faith-based organizations in providing mental health support services. Other programs are listed in the individual subcommittee sections of the report in Appendix A. In addition to programs providing direct services, participants believe that the community has excellent consumer involvement. Strong advocacy groups and a growing number of consumer and family support groups exist in the community. Although many consumers have access to medications, including more effective medications that reduce symptoms, limited access to these medications, particularly due to the high cost, is cited often as a concern. The Austin Travis County Mental Health Mental Retardation Center as well as other organizations sponsor and promote frequent publications, community forums, and varied media exposure through radio, articles, and television news coverage.

Challenges and Gaps
Infrastructure: While the number of organizations and agencies that exist in the community is cited as

a strength, participants identified several specific infrastructure needs: Housing. More affordable housing options, especially for individuals at very low levels of poverty, and more transitional living options are needed. Treatment: More hospital-based medical services are needed for people who are chemically dependent and mentally ill. Austin does not have sufficient psychiatric emergency services in a hospital setting and there are not enough detox beds. The community has a shortage of inpatient treatment beds for adults and juveniles. The community also has a shortage of outpatient treatment options and affordable counseling services that reflect ethnic diversity. Participants believe that the supply of doctors and nurses to work with patients with mental illness needs to be increased, especially medical professionals with multi-lingual skills. Technology: While some organizations providing mental health services have extensive information systems, technology and information systems for assessment and follow-up on the needs of and services to people with mental illness across organizations are needed. One specific need is to follow up with consumers who are involved in the justice system. While many participants cite evidence of communication and collaboration between agencies, not all participants agree. Some participants indicate that the coordination of services is not done effectively and that agencies compete without working together. As a result, consumers have difficulty navigating the system. Given the lack of consensus in the area of communication and collaboration, opportunities are clearly available to enhance the relationships between organizations.

have received 8 hours of mental health training and some deputies have attended an additional 40-hour mental health certification training.

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THE MAYOR’S MENTAL HEALTH TASK FORCE Policies: At the policy level, mental health issues compete for air time and attention with other pressing concerns. Two specific policy issues raised by the subcommittees include privacy issues that pose barriers to data sharing among agencies and the lack of parity in insurance coverage between mental health and physical health.

The implementation of HB 2292 by the Texas legislature is considered by participants to be problematic. The new eligibility requirements of HB 2292, passed by the Texas Legislature effective September 1, 2004, effectively limit services provided by local mental health authorities to individuals diagnosed with one of three disorders: bipolar disorder, schizophrenia, or clinically severe depression (for adults only, the target population for children was not changed, although the target population is now referred to as children with “severe emotional illness” rather than “severe emotional disturbance”). Task Force participants believe that this use of diagnostic category rather than functional ability to determine service eligibility promotes stigmatization and denies services to many other individuals with conditions that are treatable and have a high rate of recovery. The new law also requires that a disease management approach be used to treat the three priority disorders, which may result in funds being expended on the first individuals to walk in the door, with little or no funding left for others with the same diagnosis. HB 2292 eliminates therapy provided by psychologists, licensed professional counselors, licensed marriage and family therapists, and social workers to adults under Medicaid. Only psychiatrists are funded under Medicaid, and their services consist primarily of medication management, not counseling. Task Force participants fear that along with budget cuts to local mental health authorities, the effect of these legislative changes is to limit access to services and place the burden of care on local communities. Regulations and practices that keep people out of housing, such as credit history or criminal history screens, have a particularly negative impact on individuals with mental illness. An on-going challenge is how to balance the need for oversight and accountability with the desire for flexibility by service providers and the justice system.
Training: Subcommittees identify a number of specific training issues, indicating both the training curriculum that needs to be developed and the audiences that need to receive the training. In addition to specific training for those who provide services to clients with mental illnesses, funders and the community need to be educated about mental health issues as well as successes and best practices in the delivery of mental health services to diverse populations.

Consumer education is insufficient. Consumers often lack knowledge of tenants’ rights, how to advocate for mental health benefits coverage, how to address discrimination, and other issues. Consumers are faced with both ignorance and information overload about mental health and may have difficulty obtaining information about available services.
Resources: Resources, resources, resources! Participants are frustrated with the challenge of finding

resources. Services are spread thin and resources are diminishing while the population is growing. Resource issues are numerous and include recent cuts in Medicaid that eliminated counseling benefits for adults, the high cost of medications, the inability of the community to adequately serve the indigent population or the approximately 25 percent of the population that has no health insurance, and local salary scales that do not pay market rates for mental health professionals. Other specific resource issues that are mentioned include insufficient funding for education and awareness issues, prevention, rental assistance, rehabilitation of existing housing stock, and more effective diversion programs.
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THE MAYOR’S MENTAL HEALTH TASK FORCE Attitudes: Unfortunately, the stigma of mental illness persists and addressing mental health issues often is not viewed as a priority. Participants believe that media publicity about mental health is primarily negative or not relevant to different population groups and there is an opportunity to improve the frequency and quality of public service announcements about mental health. In particular, the public needs to understand that mental illness is treatable and that recovery is possible.

Consumers facing stigma may avoid self-advocacy and fear speaking up about their mental health needs. Providers experience difficulty getting successful buy-in from some consumers and getting them to participate in their planning and treatment. Consumers may deny having a mental health disorder. Although consumers can live successfully and productively in recovery, it can be difficult to communicate hope for recovery to those experiencing mental illness. Attitudes specific to housing include the difficulty landlords have in recognizing the accommodations that are necessary for individuals with a mental illness and the lack of compliance with fair housing laws. The inherent tension between the dual role of the landlord who is also serving as a service provider (i.e., demonstrating accountability and tolerance versus concern with property destruction) is difficult to manage or support. The “not in my backyard” (NIMBY) phenomenon impacts the ability to locate housing throughout the community. Many people cannot afford housing at current local wages. The business community needs to either pay a living wage or contribute to meeting housing needs in this community where housing costs are especially high.
Programs: While a number of existing programs provide essential mental health services in the

community, participants indicate that the scope of many current services needs to be expanded and many additional services are needed. Some of the areas that participants believe lack sufficient capacity or are not working well include consumer advocacy, school-based services, prevention, suicide prevention, information systems, hotlines, consistent eligibility systems, media relations, basic needs and support services, and compliance with housing laws and regulations. More detailed lists of programs needed in the community are included in the individual subcommittee sections of the report in Appendix A. One of the most pressing issues raised by each of the subcommittees is the difficulty consumers face accessing mental health services, with timeliness being especially critical. Barriers to access include multiple access portals, which may not provide the same level of assistance and knowledge about the services that are available; lack of insurance; long waiting lists; complicated paperwork; lack of sensitivity to language and other cultural issues; and restrictive eligibility for services. Consumers lack access to hospital-based emergency/crisis mental health services, especially residential services. Consumers may have difficulty finding an appropriate provider, and some providers need training in identifying and addressing mental health issues. Funding for medication is not sufficient to meet the need, especially for costly new generation medications. HB 2292 has further limited access to mental health services, including medications (see Policies, beginning on page 13, for more information). In addition, participants express concern that consumers do not always receive the most appropriate services based on their symptoms and conditions. Participants have mixed views on the involvement of the faith community. While the services provided by the faith community are identified as assets, participants also believe that the faith community could be more involved and that more training is needed in this area.

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Finally, participants say that too few programs, including treatment programs, are based on evidencebased best practices and programs often do not report favorable outcomes. In general, more quantitative data and more consistent standardized data about programs are needed, including indicators that measure program effectiveness and impact.

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Criteria for a Healthy Community
A total of 39 criteria are identified by the four Task Force subcommittees as the most critical for addressing the needs of the Austin community. The 39 criteria are shown below grouped by five categories: infrastructure, marketing, policies and plans, programs, and training and education. Within each category, the criteria are ranked by priority as determined at a combined Task Force meeting. The subcommittee origin and ranking of the criteria are indicated by the letter and number code preceding each criteria (J=Justice Systems, T=Short-and Long-term Treatment, H=Housing, E=Education and Community Awareness). In some cases, similar criteria from two or more subcommittees are combined into one criterion. The subcommittees originally demonstrated a sense of urgency in implementing the criteria by giving all but eight of the criteria immediate start dates. At a joint Task Force meeting, the criteria were prioritized within each of the categories and the start dates were adjusted accordingly. In the Action Plan section of this report (beginning on page 25), the criteria are shown in chronological order by end-date and categorized into three timeframes: those criteria that participants believe need to be completed immediately, criteria that need to be completed in the next two years, and criteria that need to be completed in six years. Appendix C includes the detailed tasks that must be undertaken to complete each criterion.

Criteria by Category
Infrastructure: This category includes infrastructure that is needed to create additional physical capacity

in the community, including psychiatric emergency service beds, detox beds, residential treatment options, housing units, and data systems for housing services. Two groups, the Justice Systems subcommittee and the Short- and Long-Term Treatment subcommittee, both had the creation of psychiatric emergency service beds in one or more local hospitals as their number one priority. Along with the Program criteria, below, these criteria are likely to be the most costly to implement, but will provide a more complete array of physical infrastructure than currently exists. Infrastructure Criteria
J 1 and T 1. A mentally healthy community has at least one Psychiatric Emergency Center in an existing hospital with a detox center attached and 24hour psychiatric emergency beds in other local hospitals. H 3. A mentally healthy community has data-driven systems to improve access to available housing options. T 3. A mentally healthy community has short- and long-term residential treatment options based on population needs. H 7. A mentally healthy community has sufficient, safe, affordable, accessible, and integrated housing units.

Start Date
2/05

End Date
10/07

2/05 6/05 10/05

11/05 10/07 10/11

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Infrastructure Criteria
J 8. A mentally healthy community has adequate inpatient and outpatient dual diagnosis treatment for substance abuse and mental health disorders for adults and juveniles.

Start Date
9/05

End Date
10/06

Marketing: Participants suggest the creation of several marketing campaigns to provide mental health

education and awareness information to the entire community, as well as to some specific audiences. The community needs to know that mental illness is a curable and treatable disease and that appropriate treatment can mitigate negative effects and even cure mental illness. This element is viewed by many members of the Education and Community Awareness subcommittee to be the foundation of all the other recommendations. Without a strong awareness campaign for diverse populations that replaces the stigma of mental illness with positive images of treatment and recovery, and without a great deal of public education regarding the continuum of mental health to mental illness, participants fear that other changes and improvements will stall based on a lack of understanding and knowledge. Marketing Criteria
E 2. A mentally healthy community has a broad-based, community-wide structure to carry on the work of the Mental Health Task Force’s education and awareness campaign. E 9. A mentally healthy community designates a staff member or department at the Austin Chamber of Commerce that is responsible for educating employers about the continuum of mental health from health to illness in order to increase productivity and decrease health care services required. E 7. A mentally healthy community develops and implements an effective mental and physical wellness communication plan targeted at the general public. T 7. A mentally healthy community increases awareness that mental health issues affect all of us –“it is us” – and promotes the concept that mentally healthy lifestyles and a mentally healthy community are shared values. E 3. A mentally healthy community communicates with the public, the faithbased community, and the media about the treatability of mental illness and the high success rates of various treatment modalities in a linguistically, ethnically, and culturally appropriate manner. E 1. A mentally healthy community utilizes social clubs, professional organizations, support groups, neighborhood groups, and faith-based communities as vehicles for community mental health education. E 6. A mentally healthy community ensures that policymakers understand the positive fiscal impact of prevention and treatment.

Start Date
4/05

End Date
3/09 (on-going) 8/05

2/05

5/05 9/05

8/05 8/07

9/05

8/10

9/05

8/07

9/05

8/07

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Marketing Criteria
T 8. A mentally healthy community provides training to promote optimal mental health emphasizing systems of care, hope, and recovery. J 10. A mentally healthy community provides training and education about how the mental health system works and roles of various stakeholders and the legal system process related to persons with mental health issues for the purpose of creating community awareness. H 9. A mentally healthy community treats all individuals with dignity and respect.

Start Date
1/06 1/06

End Date
12/08 12/08

4/05

4/05 (on-going)

Policies and plans: Several policies and plans seek to develop community standards and guidelines for

funding and delivery of mental health programs. These policies and plans include a coordinated funding plan, standards of care based on culturally competent best practices, a city-wide housing plan, a policy of parity for mental and physical health insurance coverage, a suicide prevention plan, and an informationsharing policy. When implemented, these policies and plans will more clearly define the mental health system and make it more identifiable to funders, consumers, and the community. Policies and Plans Criteria
J 2. A mentally healthy community is willing to provide adequate resources and funding for all aspects of the mental health system. T 5, J 5, and E 5. A mentally healthy community has a policy to set and maintain community standards of care for persons with mental illness in the areas of jail diversion, crisis intervention, and law enforcement training and practice based on a clear understanding of mental illness, the law, and best practice educational curricula. Linguistically and culturally competent models of best practice programs in other communities are reviewed and replicated. H 5 and H 8. A mentally healthy community has a comprehensive city-wide housing plan which incorporates the needs of special housing groups as well as inclusionary zoning, such as requiring builders to construct a percentage of affordable housing units in their developments or pay into the housing trust fund for affordable housing. (Inclusionary zoning may not be legal in the state of Texas. There will need to be further discussion and a definition created for inclusionary zoning before work begins on this criterion.) T 6. A mentally healthy community promotes parity in mental and physical healthcare benefits beginning with City and County employees and extending to enrollees in publicly funded safety-net delivery systems. E 8. A mentally healthy community maintains a culturally appropriate community suicide prevention plan that has the approval and support of the Mayor’s Office, the City Council, and the County Commissioners.

Start Date
2/05 2/05

End Date
2/10 (on-going) 8/10 (on-going)

2/05

12/06

2/05

12/08

2/05

8/05

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Policies and Plans Criteria
J 6. A mentally healthy community has policies that support the sharing of information between agencies within federal and state guidelines.

Start Date
2/05

End Date
5/06

Programs: These criteria include new or expanded programs to address specific areas of concern. They

include outpatient services available within one week of identified need; access to routine, urgent, and emergency care; supportive case management; a pre-booking system; diversion programs; a post-booking mental health and mental retardation docket; and a Partners in Education* program focused on mental health. Along with the Infrastructure criteria, some of these criteria may be costly to implement, but when implemented, they will provide a more comprehensive continuum of services that creates a more effective mental health services delivery system and ultimately reduces the cost of addressing long-neglected mental health problems. Program Criteria
T 2. A mentally healthy community has access to outpatient services within one week of identified need (i.e., medications, psychotherapy, employee assistance (EAP)-type programs). T 9. A mentally healthy community ensures ready access to routine, urgent, and emergency care for mental health and substance abuse services. H 1. A mentally healthy community has supportive case management available upon request which would prevent housing loss and access basic, emergency needs, such as emergency rental assistance, food, clothing, counseling, healthcare, shelter, utility assistance, down payment assistance, and transportation. J 3. A mentally healthy community has a pre-booking system for adults and juveniles with the authority to divert and provide appropriate services. This system is created by a committee that includes representatives from the Austin Travis County Mental Health Mental Retardation Center, law enforcement, judicial, legal, medical, social workers, and mental health consumers. J 7. A mentally healthy community has mental health criminal justice diversion programs. J 9. A mentally healthy community has a post-booking mental health and mental retardation docket for adults and juveniles with special training in mental health and mental retardation and related legal issues for all participants.

Start Date
2/05

End Date
2/07

2/05 2/05

2/10 7/07

2/06

7/06 (on-going)

5/05 2/05

7/06 7/06 (on-going)

* Partners in Education is a program of the Austin Independent School District (AISD) designed “to create and foster effective community school partnerships that support and enrich student learning and success.” The program encourages businesses, individuals, and community organizations to get involved in AISD schools.

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Program Criteria
E 12. A mentally healthy community creates a Partners in Education* program focused on mental health issues.

Start Date
12/05

End Date
1/10

Training and education: These criteria include the development of curriculum-based education and

training programs on specific topics such as appropriate crisis intervention with individuals with mental illness; housing laws and rights; local, state, and federal laws and responsibilities; promoting hope, recovery, and self-determination; and accessing funds to build, own, or modify housing. The training also targets mental health education to a variety of specific audiences, including professionals in law enforcement and the justice system, policymakers, consumers and families, students in elementary school through college, housing developers, lenders, landlords, and the faith-based community. Training and Education Criteria
J 4. A mentally healthy community has training available for specialists working in the system such as corrections, defense lawyers, prosecutors, criminal judges, probation, Crisis Intervention Team,* and any other relevant law enforcement agencies, resulting in better interactions with relevant stakeholders and persons with mental illness in the system. T 4. A mentally healthy community partners with consumers and families to promote hope, recovery, and self-determination. E 4. A mentally healthy community provides evidence-based, culturally appropriate mental health training for those who work with older adults, teens, substance abusers, people with co-occurring disorders, and people with developmental disabilities. E 10. A mentally healthy community includes mental health education in primary, secondary, and post-secondary school curricula and to first responders, including police and emergency medical technicians. T 10. A mentally healthy community provides training for support network members in the community, inclusive of non-professionals and the faith community.

Start Date
2/05

End Date
2/10 (on-going)

2/05 4/05

2/06 9/09 (on-going)

4/05

4/10 (on-going) 2/10

2/05

* The Crisis Intervention Team (CIT) is a joint program of the Austin Police Department (APD) and the Travis County Sheriff’s Office (TCSO). The CIT is charged with responding to calls involving people with mental illness, following up with mental health consumers after their initial contact with law enforcement through phone calls and home visits, transporting patients to mental health facilities across the state, and training officers locally and across the state. The CIT is housed at the Austin State Hospital and is staffed by 9 full-time sheriff’s deputies and 6 full-time APD officers. An additional 150 APD officers are designated as mental health officers. Each of these officers receives 40 hours of CIT Training (basic mental health peace officer certification). All TCSO deputies have received 8 hours of mental health training and some deputies have attended an additional 40-hour mental health certification training.

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Training and Education Criteria
H 10. A mentally healthy community has training on how to access funds to build, own, or modify housing and to access rental assistance. H 2. A mentally healthy community observes housing laws and rights for those with mental illness and to integrate individuals with a mental illness into the larger community. E 11. A mentally healthy community ensures that schools teach students and teachers to value and appreciate individual differences and lifestyle choices, including both mental and physical health conditions. H 6. A mentally healthy community has mandatory training for housing providers, bankers, lenders, developers, and others on the housing needs and rights of individuals with mental disabilities. H 4. A mentally healthy community has training for all consumers, family members, and other stakeholders on local, state, and federal laws and responsibilities. H 11. A mentally healthy community has resources to hold people and providers accountable for violating fair housing and the Americans with Disabilities Act (ADA).

Start Date
4/05 2/05

End Date
8/05 (on-going) 2/10

2/05

3/10

6/05

2/10

7/05

11/07

2/05

11/11

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Findings and Recommendations
In addition to implementing the criteria developed by the participants in the Mayor’s Task Force on Mental Health, which would address a number of the most urgent gaps in the community, several additional recommendations result from observations of the process and analysis of the work of the Task Force subcommittees.
More than funding: While funding for mental health services can be scarce, a lack of funding is not

solely responsible for perceived shortfalls or challenges in the provision of mental health services within the Austin/Travis County area. Considerable opportunities have been presented by the Task Force to educate stakeholders about the structure and function of the mental health service delivery system and to define, strengthen, and enhance the system to gain efficiencies and reduce any overlap and duplication. While costs for the criteria have not been determined, participants were urged to consider cost-neutral solutions in their planning process and some criteria in the Policies and Plans, Marketing, and Training categories may be accomplished with existing resources. strengthening policies and plans related to the delivery of mental health services that should be implemented. These criteria address the need to standardize operations and to formalize planning and will assist in creating a more unified system from any vantage point. In addition, the marketing and training criteria should be implemented to develop directed campaigns to educate all stakeholders.
Parallel efforts: A number of other mental health initiatives are underway in the community, some of

Recommendation: There are many excellent criteria from the subcommittees for

which include the Reentry Roundtable, the Jail Diversion Committee, the Children’s Mental Health Partnership, the 10-Year Plan to End Chronic Homelessness, the Community Suicide Prevention Plan, the Mental Health Subcommittee of the Jail Overcrowding Task Force, and three Community Action Network Planning Partnerships: Mental Health, Children and Youth, and Substance Abuse Planning Partnership. The action plan developed by the Mayor’s Mental Health Task Force must be coordinated with these existing initiatives. Better communication and coordination is needed between planning bodies and service providers to prioritize needs and better leverage resources for a more cohesive mental health delivery system.

Recommendation: One entity (new or existing) should be responsible for overseeing
and coordinating mental health planning initiatives and funding proposals within the community. The funding component of this responsibility is addressed in criteria J 2, which creates a funding committee to plan, prioritize and coordinate mental health funding requests. Planning efforts should also be coordinated in the same way, preferably by the same entity.

Coordinated funding plan: Budget deliberations of the newly created Hospital District, the Travis

County Commissioners Court, and the Austin City Council are either underway or will begin in spring

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2005. Many of the criteria created by the Task Force will require funding. Mental health budget requests should be consistent with the policies and plans proposed in the Task Force criteria.

Recommendation: In order to facilitate the coordination of mental health planning

and funding initiatives, the plans and policies proposed by the Task Force, once developed, should be adopted by the Travis County Commissioners Court, the Austin City Council, the Hospital District, the Austin Travis County Mental Health Mental Retardation Center, and related boards and commissions, as appropriate. This allows all planning and funding proposals submitted to these bodies to be compared to the adopted policies and plans for alignment and consistency.

Continuation of efforts: Task Force participants are very motivated by the process they have been

through and want to maintain their momentum around mental health issues. Their sense of urgency in getting started is evident in the ambitious schedule they have outlined. The agencies that have participated in the Task Force process will be involved in multiple implementation tasks, which will be an enormous undertaking.

Recommendation: The Planning Committee should finalize the membership and role
of the Task Force Monitoring Committee and form working groups to begin implementation of the action plan in each of the five areas: Infrastructure, Policies and Plans, Marketing, Programs, and Training and Education. Each working group should begin by finalizing their action plan, assigning roles and responsibilities, and monitoring implementation. The action plan should be reviewed and revised at least annually by each working group and the monitoring committee and reported to the mental health oversight committee recommended above.

Cultural relevancy: The effort that was undertaken by the Task Force focused on the mental health

needs of the entire population. While the need for culturally and linguistically appropriate services is identified in several criteria, demographic information about service recipients and the specific mental health needs of various racial and ethnic groups were not fully explored.

Recommendation: Additional work is needed to report the demographics of

consumers, identify existing programs that serve racial and ethnic minorities, and specify the current and future mental health needs of various racial and ethnic groups. This information could be collected and analyzed by one entity or by one or more of the five working groups that will implement the action plan (see the “Continuation of efforts” recommendation above).

Additional work on Marketing and Training criteria: Within the Marketing and Training

categories, more synthesis of the multiple criteria is needed to more clearly identify the gaps and develop an action plan that does not duplicate existing efforts.

Recommendation: In order to more clearly define which criteria need to be

accomplished without duplicating existing efforts, each of the working groups established to implement the action plans in the Marketing and Training categories should separately develop a matrix for their category that will more clearly identify the gaps and resource needs. Each matrix should include the following:
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- the initiative that is recommended, - the target audience, - the specific message or training that will be directed to that audience, - the entity that is best able to implement the marketing effort or training, and - whether the training can be provided with existing resources and, if not, the amount of additional resources that are needed. In addition, the matrix should show the same information for existing marketing and training efforts to be sure there is no duplication.
Best practices and evaluation: Participants suggest that too few mental health programs are based

on evidence-based best practices. More quantitative data and more consistent standardized data about programs are needed, including indicators that measure program effectiveness and impact. Some criteria call for identifying best practices in several areas and some tasks in the action plan already include an evaluation component for new initiatives; this should be extended to all of the action planning.

Recommendation: Each working group formed to implement the action plan in

each of the five categories should engage in a process of identifying best practices in place in other communities to guide and inform their planning. Each working group should include in their action plan a process for evaluating the effectiveness of the criteria that are implemented.

Measuring a mentally healthy community: The Task Force Planning Committee was interested in

quantifying the strengths and gaps in the community and developing quantifiable measures for each criterion, but this process did not prove to be the appropriate forum for producing quantifiable data. This process did identify, however, areas where additional data are needed, such as the number of housing units needed and the number that are available. In addition, an extensive search for the criteria that other communities are using to measure mental health did not identify any communities that are known to be measuring mental health beyond the common use of suicide rates and substance abuse-related measures.

Recommendation: The mental health oversight entity should work toward the

development of a “mental health dashboard” to measure the progress and impact of the criteria that have been developed, something that no other community is known to be doing. This “dashboard” would include a handful of measures that define a healthy community and give information on both process and outcomes, such as the number of people living in recovery, the number of people served, and the number of people on waiting lists for various services.

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Action Plan
A sense of urgency is evident among the participants on the Task Force. More than half of the 39 criteria identified in the subcommittees have been given a completion date within the next two years. The criteria are shown below in chronological order by end date. Appendix C contains the detailed action plans from each subcommittee that include the tasks that must be completed to accomplish each of the criteria. Implementation of the action plan requires considerable further commitment from the organizations that participated in this Task Force. Because organizations and individuals are identified as participating in multiple tasks regarding each of the 39 criteria over the next six years, the action plan, as developed, will be a very ambitious undertaking. The subcommittee origin and ranking of each criteria is indicated by the letter and number code preceding each criteria (J=Justice Systems, T=Short-and Long-term Treatment, H=Housing, E=Education and Community Awareness).

Monitoring Committee
The Executive Committee of the Austin Travis County Mental Health Mental Retardation Center Board of Directors has approved a request from Mayor Will Wynn to create a subcommittee of the Board that will serve as the Monitoring Committee for the Mayor’s Mental Health Task Force. The Monitoring Committee will perform a resource and coordination role in the implementation of the Action Plan created by the Task Force. Specifically, the role of the Monitoring Committee is to: Take a lead role in monitoring and facilitating the implementation of Task Force criteria. Assist existing groups and organizations that accept ownership for implementing Task Force criteria. Take a lead role in establishing new approaches and teams to address Task Force criteria that cannot be accomplished by an existing group or organization. Oversee the development of a long-term strategic plan for gaps that have been identified. Act as a resource to identify possible funding and other resources. The Monitoring Committee will serve for a five-year period of time and will report to the Mayor annually.

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Immediate
The following criteria will be accomplished by the end of 2005. Category
Marketing Policies/Plans

Criteria
H 9. A mentally healthy community treats all individuals with dignity and respect. E 8. A mentally healthy community maintains a culturally appropriate community suicide prevention plan that has the approval and support of the Mayor’s Office, the City Council, and the County Commissioners. H 10. A mentally healthy community has training on how to access funds to build, own, or modify housing and to access rental assistance. E 7. A mentally healthy community develops and implements an effective mental and physical wellness communication plan targeted at the general public. E 9. A mentally healthy community designates a staff member or department at the Austin Chamber of Commerce that is responsible for educating employers about the continuum of mental health from health to illness in order to increase productivity and decrease health care services required. H 3. A mentally healthy community has data-driven systems to improve access to available housing options.

Start Date
4/05 2/05

End Date
4/05 (ongoing) 8/05

Training/ Education Marketing Marketing

4/05 5/05 2/05

8/05 (ongoing) 8/05 8/05

Infrastructure

2/05

11/05

Short-term (2 years)
The following criteria will be accomplished in 2006 and 2007. Category
Training/ Education Policies/Plans Programs

Short-term Criteria (2 years)
T 4. A mentally healthy community partners with consumers and families to promote hope, recovery, and self-determination. J 6. A mentally healthy community has policies that support the sharing of information between agencies within federal and state guidelines. J 9. A mentally healthy community has a post-booking mental health and mental retardation docket for adults and juveniles with special training in mental health and mental retardation and related legal issues for all participants. J 7. A mentally healthy community has mental health criminal justice diversion programs.

Start Date
2/05 2/05 2/05

End Date
2/06 5/06 7/06 (ongoing) 7/06

Programs

5/05

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Category
Programs

Short-term Criteria (2 years)
J 3. A mentally healthy community has a pre-booking system for adults and juveniles with the authority to divert and provide appropriate services. This system is created by a committee that includes representatives from the Austin Travis County Mental Health Mental Retardation Center, law enforcement, judicial, legal, medical, social workers, and mental health consumers. J 8. A mentally healthy community has adequate inpatient and outpatient dual diagnosis treatment for substance abuse and mental health disorders for adults and juveniles. H 5 and H 8. A mentally healthy community has a comprehensive city-wide housing plan which incorporates the needs of special housing groups as well as inclusionary zoning, such as requiring builders to construct a percentage of affordable housing units in their developments or pay into the housing trust fund for affordable housing. (Inclusionary zoning may not be legal in the state of Texas. There will need to be further discussion and a definition created for inclusionary zoning before work begins on this criterion.) T 2. A mentally healthy community has access to outpatient services within one week of identified need (i.e., medications, psychotherapy, employee assistance (EAP)-type programs). H 1. A mentally healthy community has supportive case management available upon request which would prevent housing loss and access basic, emergency needs, such as emergency rental assistance, food, clothing, counseling, healthcare, shelter, utility assistance, down payment assistance, and transportation. E 6. A mentally healthy community ensures that policymakers understand the positive fiscal impact of prevention and treatment. T 7. A mentally healthy community increases awareness that mental health issues affect all of us –“it is us” – and promotes the concept that mentally healthy lifestyles and a mentally healthy community are shared values. E 1. A mentally healthy community utilizes social clubs, professional organizations, support groups, neighborhood groups, and faith-based communities as vehicles for community mental health education. J 1 and T 1. A mentally healthy community has at least one Psychiatric Emergency Center in an existing hospital with a detox center attached and 24hour psychiatric emergency beds in other local hospitals. T 3. A mentally healthy community has short- and long-term residential treatment options based on population needs.

Start Date
2/06

End Date
7/06 (ongoing)

Infrastructure

9/05

10/06

Policies/Plans

2/05

12/06

Programs

2/05

2/07

Programs

2/05

7/07

Marketing Marketing

9/05 9/05

8/07 8/07

Marketing

9/05

8/07

Infrastructure

2/05

10/07

Infrastructure

6/05

10/07

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Category
Training/ Education

Short-term Criteria (2 years)
H 4. A mentally healthy community has training for all consumers, family members, and other stakeholders on local, state, and federal laws and responsibilities.

Start Date
7/05

End Date
11/07

Long-term (3-6 years)
The following criteria will be accomplished between 2008 and 2011. Category
Policies/Plans

Long-term Criteria (3-6 years)
T 6. A mentally healthy community promotes parity in mental and physical healthcare benefits beginning with City and County employees and extending to enrollees in publicly funded safety-net delivery systems. J 10. A mentally healthy community provides training and education about how the mental health system works and roles of various stakeholders and the legal system process related to persons with mental health issues for the purpose of creating community awareness. T 8. A mentally healthy community provides training to promote optimal mental health emphasizing systems of care, hope, and recovery. E 2. A mentally healthy community has a broad-based, community-wide structure to carry on the work of the Mental Health Task Force’s education and awareness campaign. E 4. A mentally healthy community provides evidence-based, culturally appropriate mental health training for those who work with older adults, teens, substance abusers, people with co-occurring disorders, and people with developmental disabilities. E 12. A mentally healthy community creates a Partners in Education* program focused on mental health issues. J 2. A mentally healthy community is willing to provide adequate resources and funding for all aspects of the mental health system.

Start Date
2/05

End Date
12/08

Marketing

1/06

12/08

Marketing Marketing

1/06 4/05

12/08 3/09 (ongoing) 9/09

Training/ Education

4/05

Programs Policies/Plans

12/05 2/05

1/10 2/10 (ongoing)

* Partners in Education is a program of the Austin Independent School District (AISD) designed “to create and foster effective community school partnerships that support and enrich student learning and success.” The program encourages businesses, individuals, and community organizations to get involved in AISD schools.

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Category
Training/ Education Training/ Education Training/ Education

Long-term Criteria (3-6 years)
T 10. A mentally healthy community provides training for support network members in the community, inclusive of non-professionals and the faith community. H 2. A mentally healthy community observes housing laws and rights for those with mental illness and to integrate individuals with a mental illness into the larger community. J 4. A mentally healthy community has training available for specialists working in the system such as corrections, defense lawyers, prosecutors, criminal judges, probation, Crisis Intervention Team,* and any other relevant law enforcement agencies, resulting in better interactions with relevant stakeholders and persons with mental illness in the system. T 9. A mentally healthy community ensures ready access to routine, urgent, and emergency care for mental health and substance abuse services. H 6. A mentally healthy community has mandatory training for housing providers, bankers, lenders, developers, and others on the housing needs and rights of individuals with mental disabilities. E 11. A mentally healthy community ensures that schools teach students and teachers to value and appreciate individual differences and lifestyle choices, including both mental and physical health conditions. E 10. A mentally healthy community includes mental health education in primary, secondary, and post-secondary school curricula and to first responders, including police and emergency medical technicians. T 5, J 5, and E 5. A mentally healthy community has a policy to maintain and expand community standards for persons with mental illness in the areas of jail diversion, crisis intervention, and law enforcement training and practice based on a clear understanding of mental illness, the law, and best practice educational curricula. Linguistically and culturally competent models of best practice programs in other communities are reviewed and replicated.

Start Date
2/05

End Date
2/10

2/05

2/10

2/05

2/10 (ongoing)

Programs Training/ Education Training/ Education Training/ Education Policies/Plans

2/05 6/05

2/10 2/10

2/05

3/10

4/05

4/10

2/05

8/10 (ongoing)

* The Crisis Intervention Team (CIT) is a joint program of the Austin Police Department (APD) and the Travis County Sheriff’s Office (TCSO). The CIT is charged with responding to calls involving people with mental illness, following up with mental health consumers after their initial contact with law enforcement through phone calls and home visits, transporting patients to mental health facilities across the state, and training officers locally and across the state. The CIT is housed at the Austin State Hospital and is staffed by 9 full-time sheriff’s deputies and 6 full-time APD officers. An additional 150 APD officers are designated as mental health officers. Each of these officers receives 40 hours of CIT Training (basic mental health peace officer certification). All TCSO deputies have received 8 hours of mental health training and some deputies have attended an additional 40-hour mental health certification training.

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Category
Marketing

Long-term Criteria (3-6 years)
E 3. A mentally healthy community communicates with the public, the faithbased community, and the media about the treatability of mental illness and the high success rates of various treatment modalities in a linguistically, ethnically, and culturally appropriate manner. H 7. A mentally healthy community has sufficient, safe, affordable, accessible, and integrated housing units. H 11. A mentally healthy community has resources to hold people and providers accountable for violating fair housing and the Americans with Disabilities Act (ADA).

Start Date
9/05

End Date
8/10

Infrastructure Training/ Education

10/05 2/05

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Appendix A: Subcommittee Reports
This Appendix contains summaries of the discussions of each of the four Task Force subcommittees: Justice Systems, Short- and Long-term Treatment, Housing, and Education and Community Awareness. These sections reflect the many viewpoints within in each subcommittee and, in some cases, participants’ views and related comments are contradictory. The accuracy of the comments made by participants has not been checked and some comments may be based on perception rather than on fact. Please see the Assessment section of the report (page 10) for more discussion about apparent contradictions. The criteria listed in each subcommittee section of the Appendix reflect the final decisions of each subcommittee. These criteria may have been combined and reworded as a result of a combined Task Force meeting to prioritize the criteria across subcommittees. The final list of criteria can be found in the Criteria section of the report (page 16).

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Justice Systems Subcommittee
The Past
Positive Changes
Attitudes: Austin has improved and increased training for first responders. Better education and

awareness about mental health issues is provided to justice system professionals.
Programs: The quality of legal representation for individuals with mental illness has improved and the

justice system does a better job with community reentry and transition. Outpatient systems such as psychiatric emergency services and other crisis intervention programs have been created. Jail personnel are better able to identify mental health needs of inmates earlier. Mental health patients now have access to a new generation of medications. The legal system is better able to determine who is competent to stand trial. Negative Changes and Causes for Concern
Resources: The cost of medications has increased substantially, although pharmaceutical companies are

believed to be subsidizing up to a third of these costs. State funding for medication has decreased. Overall, spending has not kept up with the increases in the general population and inflation. Many mental health service providers stress the need
Programs: Although the quality of legal representation goal of providing services to clients in their homes by has improved, participants indicate that a great need for providing whatever services a family needs to function well. Services are tailored to each family's physical, high quality legal representation continues. Because of health, and educational fewer inpatient services at Austin State Hospital, patients emotional, social, behavioral are coordinated by the needs. Appropriate services depend more on outpatient and monitoring services, social service system in a manner that supports the desired outcomes of the family. resulting in a greater need for a systems of care model (see box at right for explanation). More people in jail have been identified as having co-occurring disorders (mental illness and mental retardation) than in the past. People with mental health issues often are in jail due to lack of available services.
for community-based integrated S Y S T E M S O F C A R E or “wrap-around” service models that have a

The Present
Strengths
Infrastructure: Austin has a wealth of concerned and knowledgeable people (community leaders,

government, elected officials, and the general public) and committed, involved agencies and organizations such as the University of Texas Schools of Law and Social Work, the Hogg Foundation for Mental Health, Advocacy, Inc., Texas Appleseed, Texas Civil Rights Project, the National Alliance for the
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Mentally Ill (Austin Chapter), Capacity for Justice, Mental Health Association, Texas Task Force on Indigent Defense, the Texas Correctional Office on Offenders with Medical or Mental Impairments, and the Austin Travis County Mental Health Mental Retardation Center. Concern over mental health issues has resulted in the formation of several study committees and task forces over the years. Participants cited specifically a 2001 study with a map of the mental health system, including law enforcement functions. A county Hospital District has recently been created, which is considered a positive asset to the community. The fact that judges, prosecutors, and defense lawyers are interested, committed, involved, and willing to receive training on mental health issues is a strength for the justice system.
Resources: One strength is the continued funding for the Austin Travis County Mental Health Mental

Retardation Center by the City of Austin and Travis County.
Attitudes: Positive attitudes exist within the community and include compassion and tolerance. Austin is a concerned, proactive community willing to address mental health issues through cooperation and collaboration. The community is progressive and willing to change and try new things. Programs: Several specific programs are cited by subcommittee participants, including:

Community Court in the City of Austin, a class C criminal court that hears cases involving people who are homeless, mentally ill, or mentally disabled. Treatment and medication services in jail, as jails have become providers of mental health services. All arrestees have an initial mental health screening and counselors evaluate most people that are arrested and have mental health issues.

The special needs diversionary program for juvenile offenders. The Travis County Sheriff’s Office and Austin Police Department’s joint Crisis Intervention Team*. The special prosecution unit in the Travis County Attorney’s Office and the public defender for civil commitments.

* The Crisis Intervention Team (CIT) is a joint program of the Austin Police Department (APD) and the Travis County Sheriff’s Office (TCSO). The CIT is charged with responding to calls involving people with mental illness, following up with mental health consumers after their initial contact with law enforcement through phone calls and home visits, transporting patients to mental health facilities across the state, and training officers locally and across the state. The CIT is housed at the Austin State Hospital and is staffed by 9 full-time sheriff’s deputies and 6 full-time APD officers. An additional 150 APD officers are designated as mental health officers. Each of these officers receives 40 hours of CIT Training (basic mental health peace officer certification). All TCSO deputies have received 8 hours of mental health training and some deputies have attended an additional 40-hour mental health certification training.

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The Austin Travis County Mental Health Mental Retardation’s ANEW program that provides mental health services to incarcerated and released individuals with mental illness.

Mental health staff at the jail and trained individuals within some of the court units who better recognize mental health issues. The Travis County Juvenile Probation mental health assessment unit.

The entities in the community that are responsible for these strengths include but are not limited to: Medical hospitals Crisis Intervention Team Austin Travis County Mental Health Mental Retardation Center City and County Law Enforcement (Austin Police Department and Travis County Sheriff’s Office) Public Defender for Civil Commitments Challenges and Gaps The majority of the gaps identified are services and strategies that Austin does not have or is not implementing in a consistent way across the community. The following services were highlighted in the discussion:
Infrastructure: Infrastructure challenges fall into two primary categories:

Probate Court Austin State Hospital Travis County Juvenile Probation Department Juvenile Public Defenders Office Representative Naishtat and Senator Barrientos Austin Travis County Health and Human Services Department

Communication and coordination. Although participants cite cooperation and coordination of the many organizations involved in mental health services as a strength, participants also indicated that there are many opportunities for improvement and expansion in this area. Specifically, the community needs: Consensus building to speak with one voice and to collaborate and work together and make decisions. Better coordination of information about the mentally ill in the justice system. A contiguous/seamless procedures system. Resource coordination to address service fragmentation. Better communication between entities and agencies. Technology and information systems for assessing and tracking the needs of people with mental illness in the justice system. Methods to make the system easier to traverse for consumers. The involvement of the hospitals and medical community.

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Hospital-based emergency and inpatient services: Participants indicate that the Austin community lacks or needs more of the following hospital-based services: Hospital-based medical services for people who are chemically dependent and mentally ill. Inpatient beds at public hospitals for adults. Inpatient beds for juveniles. More detox and alcohol treatment for the indigent outside of jail or detention. Emergency treatment/psychiatric emergency services in a hospital setting.

Training: Challenges include the ability to provide assistance and get expertise to professionals and staff in the legal system. Training is needed for lawyers and to develop a mental health public defenders office. For consumers, job training opportunities for both adults and juveniles are limited. Resources: Resources, resources, resources! Participants indicate that it is hard to find resources.

Resources and, in some cases, commitment, are lacking. Specifically, resources for diversion (which is not working well) are lacking. The cost of medications is a concern.
Attitudes: The stigma of mental illness persists. Successful participation by consumers in their own

planning and treatment is difficult to achieve.
Programs: Participants identified a number of specific program challenges, including the need for:

Timely access to services in this community (so people do not have to be sent elsewhere for services). Access to medication. Specialization in court and attorney system for mental health for adults and juveniles. Social workers are needed in the justice system. Identifying individuals’ needs and matching needs with appropriate resources. Outpatient services. Community corrections officers for specialized case loads in the adult and juvenile probation system. More child psychiatry services.

A successful eligibility evaluation system that is consistent across agencies and courts. Adequate legal services. Assessing the effectiveness of services in the community. More housing options, especially transitional living for older adults. Eliminating roadblocks for clients to receive services. Forensic evaluators for competency and sanity. Coordination of treatment.

The services that the community needs more of include, but are not limited to: More city and county funding for services. More mental health assessment resources for juvenile offenders. More mental health professionals for the jails.

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Those responsible for filling these gaps include, but are not limited to: Austin/Travis County Health and Human Services Travis County Sheriff’s Office Austin Police Department Travis County Juvenile Probation Texas Society of Psychiatric Physicians County Commissioners Courts Judges Texas Legislature Capacity for Justice Austin Travis County Mental Health Mental Retardation Center Federally Qualified Health Centers Department of Aging and Disability Services Mayor’s Mental Health Task Force Texas Juvenile Probation Commission Hospital District Medical community Mental health advocates

The Future
Working in three groups, with one group writing their vision of the future, one group drawing their vision of the future, and one group using building blocks and other three-dimensional objects to depict their vision of the future, participants envision a future that has many interesting characteristics. The group describing their vision with words produced the following work: Hospitals Public hospital-based psychiatric emergency services with inpatient beds for short-term stays. The hospital would have a separate “sobriety center” that would include a detox and “sobering up” facility. The hospital would assess clients for mental health and substance use treatment after they are sober. After the sobriety assessment, they could be diverted to a substance abuse or mental health treatment program. Criminal System Specialized units in the jails (these already exist). A variety of response options, such as deferred prosecution programs and a mental health court at the misdemeanor and felony levels, along with municipal court. Misdemeanor and felony court could be combined, which would require legislative change. Clients would be represented by a mental health public defender. Availability of rapid access back to mental health court or inpatient treatment for relapse issues. The group presenting their vision in a visual format created the following vision: Jails and hospitals are smaller entities, community services are bigger entities; The different resources are connected to one another through technology such as phones as well as more physical means such as hike and bike trails; Support of the faith-based community;
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Open door to services; Schools have mental health services. The group working on a three-dimensional scale created a “Mall of Services” with the following characteristics: Single entry points both at the front door and back door; All things were connected; All services are available from the entrance; Coordination of care is a long-term component; Technology links services; Outreach program provides long-term follow-up; Jail is not the first step to receiving treatment; You should be able to enter at any point in the system and qualify for services; Move the mental health jail component to the mall of services.

Criteria for a Mentally Healthy Community
Participants were organized into three groups with each selecting criteria for two of the six categories (infrastructure, resources, policies, programs, training, and attitudes) and developing criteria in each category. The groups were then instructed to utilize the following guidelines in prioritizing their top three choices in each of the six categories: At least one of the criteria must be cost-neutral; Must be feasible and measurable; Must have significant impact; Reflects evidence-based or best practices; Is innovative/creative/out-of-the-box thinking; Addresses an identified gap. Each of the groups then presented their top three choices to the whole group and explained why they had prioritized those criteria. The members of the group were each given six votes to cast for those criteria they believed were most important, with the objective of identifying the top twelve criteria. After discussion and some consolidation, ten criteria resulted and are listed below in priority order:
J 1. A mentally healthy community has 24-hour psychiatric emergency beds in local hospitals. J 2. A mentally healthy community is willing to provide adequate resources and funding for all aspects of the mental health system. J 3. A mentally healthy community has a pre-booking system for adults and juveniles with the authority to divert and provide appropriate services. This system is created by a committee that includes representatives from the Austin Travis County Mental Health Mental Retardation Center, law enforcement, judicial, legal, medical, social workers, and mental health consumers.

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J 4. A mentally healthy community has training available for specialists working in the system such as corrections, defense lawyers, prosecutors, criminal judges, probation, Crisis Intervention Team,* and any other relevant law enforcement agencies, resulting in better interactions with relevant stakeholders and persons with mental illness in the system. J 5. A mentally healthy community has policies that set the standard of care for people with mental illness, such as jail diversion programs. J 6. A mentally healthy community has policies that support the sharing of information between agencies within federal and state guidelines. J 7. A mentally healthy community has mental health criminal justice diversion programs. J 8. A mentally healthy community has adequate inpatient and outpatient dual diagnosis treatment for substance abuse and mental health disorders for adults and juveniles. J 9. A mentally healthy community has a post-booking mental health and mental retardation docket for adults and juveniles with special training in mental health and mental retardation and related legal issues for all participants. J 10. A mentally healthy community provides training and education about how the mental health system works and roles of various stakeholders and the legal system process related to persons with mental health issues for the purpose of creating community awareness.

* The Crisis Intervention Team (CIT) is a joint program of the Austin Police Department (APD) and the Travis County Sheriff’s Office (TCSO). The CIT is charged with responding to calls involving people with mental illness, following up with mental health consumers after their initial contact with law enforcement through phone calls and home visits, transporting patients to mental health facilities across the state, and training officers locally and across the state. The CIT is housed at the Austin State Hospital and is staffed by 9 full-time sheriff’s deputies and 6 full-time APD officers. An additional 150 APD officers are designated as mental health officers. Each of these officers receives 40 hours of CIT Training (basic mental health peace officer certification). All TCSO deputies have received 8 hours of mental health training and some deputies have attended an additional 40-hour mental health certification training.

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Short- and Long-Term Treatment Subcommittee
The Past
Positive Changes
Resources: Service providers practice better stewardship of public dollars than in the past. Attitudes: The community has greater awareness and knowledge of mental health issues and greater expectations. Consumer awareness and responsiveness is valued and promoted. Programs: Positive programmatic changes include:

Better knowledge and understanding of treatment that works, i.e., evidence-based practices. Briefer treatment models are being used. Patient “rights” are being re-defined and patients have more control over their own treatment process.

More persons with mental disorders are accessing behavioral health services through their primary care physicians. More consumer advocacy groups exist today. Higher expectations regarding cultural sensitivity.

Negative Changes and Causes for Concern
Resources: Fewer services are available through Medicaid and other financial resources are decreasing. Attitudes: The stigma of mental illness persists. Programs: Concerns about programmatic changes include:

Insufficient case management is available. Fewer intact families mean less family support for consumers. The mental health field has moved away from supports and more toward medical interventions, primarily medications. Treatment decisions are now driven by insurance limits, causing rationing of treatment.
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Fewer patients are in hospitals, more are incarcerated - the deinstitutionalization of consumers has led to jails becoming de facto providers of treatment. New generation medications are better, but there are fewer treatment options for followup support.

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The criteria for institutional commitment have become very narrow. The population is aging and few geriatric services exist that focus on mental health.

Clients are expected to function more in the mainstream, which may be difficult for some clients.

The Present
Strengths
Infrastructure: The strengths fall primarily into two categories:

Organizations and entities: The following are assets to the community: Austin Travis County Mental Health Mental Retardation Center. The location of Austin State Hospital. State agencies and research/data/public policy organizations are headquartered here. Pharmaceutical research companies within the city. Private residential care such as Meridell. Children’s System of Care Initiative. Texas Mental Health Consumers. Indigent Care Collaboration. Faith-based community. Travis County Hospital District. Texas Federation of Families for Children’s Mental Health. The E-Merge program.* SIMS Foundation. VA clinic. Community-based substance abuse programs. PLAN of Central Texas (provides long-term support). Self-Help Advocacy Center (SHAC). Private not-for-profit treatment center in hospitals (e.g. Seton Shoal Creek). National Alliance of the Mentally Ill (NAMI) Education Programs (e.g. Family to Family courses). Texas Mental Health Association. Hogg Foundation for Mental Health.

The E-Merge program teams Austin Travis County Mental Health Mental Retardation behavioral health providers with primary care providers at Austin-Travis County Community Health Center sites to improve assessment and treatment of primary care patients with depression, anxiety, and other common mental health disorders.
*

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Communication and coordination: The following are examples of coordination among organizations involved in mental health services: A good relationship exists between the Austin Travis County Mental Health Mental Retardation Center and the Austin State Hospital. The emphasis on collaborations evidenced by the Children’s Partnership, Community Action Network, and the National Alliance for the Mentally Ill (Austin Chapter). A good relationship exists between the Austin/Travis County Community Mental Health Centers and the Austin Travis County Mental Health Mental Retardation Center. Databases exist for law enforcement, the homeless, and behavioral health. Judge Herman’s monthly meetings involving involuntary admissions. Collaborative relationships between private providers. A good relationship exists between the Austin Travis County Mental Health Mental Retardation Center and the Austin/Travis County Health and Human Services and Veterans Services Department.

In addition, Austin has an educated workforce because of the multiple educational resources and a residency program for psychiatrists.
Training: The proximity to the Capitol and the Legislature provides opportunities to educate elected

officials.
Resources: Private resources are available. Attitudes: Positive attitudes are demonstrated by:

High knowledge levels within the community about mental health due to institutions of higher education and their faculty. Awareness of the need for mental health services. The community’s commitment to diversity.

Community willingness to address mental health issues, particularly demonstrated by government support and community forums. Compassion within the community, i.e., the Crisis Intervention Team* and the creation of the Mayor’s Mental Health Task Force.

* The Crisis Intervention Team (CIT) is a joint program of the Austin Police Department (APD) and the Travis County Sheriff’s Office (TCSO). The CIT is charged with responding to calls involving people with mental illness, following up with mental health consumers after their initial contact with law enforcement through phone calls and home visits, transporting patients to mental health facilities across the state, and training officers locally and across the state. The CIT is housed at the Austin State Hospital and is staffed by 9 full-time sheriff’s deputies and 6 full-time APD officers. An additional 150 APD officers are designated as mental health officers. Each of these officers receives 40 hours of CIT Training (basic mental health peace officer certification). All TCSO deputies have received 8 hours of mental health training and some deputies have attended an additional 40-hour mental health certification training.

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THE MAYOR’S MENTAL HEALTH TASK FORCE Programs: Several specific program strengths are cited by subcommittee participants, including:

Development of the Crisis Intervention Team. Strong victims services organizations. Strong network of support groups. Early intervention in schools. Mental health expertise levels are high. A variety of resources exist. Austin psychiatric residency program. Children’s mental health services. Managed services model using public dollars.

Bluebonnet Trails Mental Health and Mental Retardation Center. Integrated mental health, substance abuse, and primary care services for the medically indigent (E-Merge). Variety of substance abuse services ranging from outpatient to residential. Dual diagnosis counseling program at the YWCA. Universities and colleges involved in training future mental health professionals.

The entities in the community that are responsible for these strengths include, but are not limited to: Austin Travis County Mental Health Mental Retardation Center Community Action Network Faith-based organizations Private foundations State programs Austin Child Guidance Center Lifeworks The Children’s Partnership Safeplace City of Austin and Travis County Seton Shoal Creek Hospital

The services that the community needs more of include, but are not limited to: More of all of the services that already exist. More intermediate counseling/therapy (e.g., 10 sessions or less). More services for non-priority populations. More access to medication for non-priority populations. Challenges and Gaps The majority of the gaps identified are services and strategies that Austin does not have, or are not implementing in a consistent way across the community. The following were highlighted in the discussion:
Infrastructure: Participants acknowledge a need for improved coordination between social service

agencies and more collaboration between the public and private sector. Some participants are especially critical of the level of communication between organizations. A mobile population is cited as one reason that effective communication is vital. Without effective communication, consumers have difficulty traversing the system. Participants indicate that there are not enough detox beds in Austin and that the supply of doctors and nurses to work with mentally ill patients is limited.
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Policies: Participants on this subcommittee are concerned about the balance between accountability and

oversight and the ability to be flexible. The commitment process is cited as one example where mental health professionals may have too little flexibility. A similar issue is raised regarding data shared through information technology, where concerns over privacy issues may supercede the need to share information to improve service delivery. Another policy issue that impacts the delivery of mental health service delivery is the lack of parity in insurance coverage of physical health and mental health. Texas House Bill 2292 has made significant changes in the delivery of mental health services. The new eligibility requirements of HB 2292, passed by the Texas Legislature effective September 1, 2004, effectively limit services provided by local mental health authorities to individuals diagnosed with one of three disorders: bipolar disorder, schizophrenia, or clinically severe depression (for adults only, the target population for children was not changed, although the target population now refers to children with “severe emotional illness” rather than “severe emotional disturbance”). In addition to denying services to many other individuals with conditions that are treatable and have a high rate of recovery, Task Force participants believe that this use of diagnostic category rather than functional ability to determine service eligibility promotes stigmatization. The new law also requires that a disease management approach be used to treat the three priority disorders, which may result in funds being expended on the first individuals to walk in the door, with little or no funding left for others with the same diagnosis. HB 2292 eliminates therapy provided by psychologists, licensed professional counselors, licensed marriage and family therapists, and social workers to adults under Medicaid. Only psychiatrists are funded under Medicaid, and their services consist primarily of medication management, not counseling. Along with budget cuts to local mental health authorities, the effect of these legislative changes is to limit access to services and place the burden of care on local communities.
Training: This subcommittee indicates that education in general is a challenge, but raises two specific

training needs: training in dealing with mental illness for non-mental health personnel who are providing services in the community (i.e., training for Meals on Wheels and More volunteers) and educating legislators about mental health.
Resources: Funding for mental health services is a challenge -- there are limited resources and a

growing population. Among the challenges are recent changes in the Medicaid program that eliminated funding for mental health services for adults provided by psychologists, social workers, licensed professional counselors, case managers, and marriage and family therapists in most settings; local salary scales that do not pay market rates for mental health professionals; the inability of the community to adequately serve the indigent or the 25 percent of the population that has no health insurance; and the high costs of medication.
Attitudes: The stigma of mental illness persists. Although consumers can live successfully and productively in recovery, hope for recovery is not often communicated to those experiencing mental illness. The public needs to understand that mental illness is treatable and that recovery is possible.

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THE MAYOR’S MENTAL HEALTH TASK FORCE Programs: Challenges include the following:

Timely access to programs and services. Insufficient capacity of programs and services. Access to psychiatric services for private pay patients or for those with no insurance. Not enough services for students, including college students. The need for psychiatric care within the jails. Consumers may not get the most appropriate therapy or services based on their symptoms and conditions. Access to medications. The length of time to be seen by a psychiatrist for an evaluation and prescription for medications can be excessive, particularly when clients run out of their medications and need another prescription. Families who are aging and trying to care for adult children with mental illness now have heavier responsibilities. Consumers may have difficulty communicating the depth of their problems (both physical and mental).

Given the complex and competing needs within the community, mental health is often not a priority. Housing, employment, and transportation are frequently encountered barriers for those with mental illness. Follow-up care is insufficient. Information about available services is sometimes difficult to obtain, making it hard for consumers to find services. Assistance is needed for consumers to establish and sustain self-help resources and support systems. The current mental health system tends to be crisis based. A better balance between early intervention and crisis intervention is needed, with increased investment in earlier intervention. Better coordination of treatment is needed. Implementation of evidence-based or best practices.

Those responsible for filling these gaps include, but are not limited to: All of us Government Policy makers Institutions of higher education Medical profession Faith-based communities Schools Providers

The Future
Working in three groups, with one group writing their vision of the future, one group drawing their vision of the future, and one group using building blocks and other three-dimensional objects to depict their vision of the future, participants envision a future that has many interesting characteristics. The group describing their vision with words produced the following work: We would have a more connected, supportive, educated community available to reach out at all levels; More seamless delivery of services;
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A comprehensive continuum of services with activities and services that promote healthy behaviors, early detection, early intervention; An emphasis on values -- i.e., supporting family, building relationships and recovery/support systems, enhancing life skills training; One-stop shopping for assessment and comprehensive treatment. The group presenting their vision in a visual format created the following vision: Consumer has the “key” to unlock access; Increased communication between all entities; Increased agency collaboration; Increased positive outcomes; Adequate financial resources; Consumers would participate in well-rounded healthy lifestyles, including recreation, employment, education, housing and spirituality; Basic needs such as transportation would be provided; Community support teams would wrap around consumers; The community would accept those with mental illness without judgment or stigma. The group working on a three-dimensional scale created a “Maslow’s Village” with the following characteristics: Family at the center of an unbroken circle; “Heart” (compassion and caring) built into service delivery; Housing, food, basic needs, transportation are all provided; Multi-service healthcare system that includes mental health; “Movers and Shakers” are close to services to ensure funding; Respite services are available; Smaller percent of mental health population entering the criminal justice system; Continuing education for family and community as a part of healthy lifestyle and good mental health; Strong community connection with others; Life line for access, i.e., how to find services, how to get services; Old system equals “Jurassic Age,” which must be left behind to build new system to serve community better.

Criteria for a Mentally Healthy Community
Participants were organized into three groups, with each selecting criteria for two of the six categories (infrastructure, resources, policies, programs, training, and attitudes) and developing criteria in each category. The groups were then instructed to utilize the following guidelines in prioritizing their top three choices in each of the six categories: At least one of the criteria must be cost-neutral; Must be feasible and measurable; Must have significant impact; Reflects evidence-based or best practices;
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Is innovative/creative/out-of-the-box thinking; Addresses an identified gap. Each of the groups then presented their top three choices to the whole group and explained why they had prioritized those criteria. The members of the group were each given six votes to cast for those criteria they believed were most important, with the objective of identifying the top twelve criteria. After discussion and some consolidation, ten criteria resulted and are listed below in priority order:
T 1. A mentally healthy community has at least one Psychiatric Emergency Center in an existing hospital with a detox center attached. T 2. A mentally healthy community has access to outpatient services within one week of identified need (i.e., medications, psychotherapy, employee assistance (EAP)-type programs). T 3. A mentally healthy community has short- and long-term residential treatment options based on population needs. T 4. A mentally healthy community partners with consumers and families to promote hope, recovery, and selfdetermination. T 5. A mentally healthy community has a policy to maintain and expand a community practice standard (e.g. practice standards in the Crisis Intervention Team* curriculum) across law enforcement and public safety agencies for “crisis intervention” based on a clear understanding of mental illness, the law, and best practice educational curricula. T 6. A mentally healthy community promotes parity in mental and physical healthcare benefits beginning with City and County employees and extending to enrollees in publicly funded safety-net delivery systems. T 7. A mentally healthy community increases awareness that mental health issues affect all of us –“it is us” – and promotes the concept that mentally healthy lifestyles and a mentally healthy community are shared values. T 8. A mentally healthy community provides training to promote optimal mental health emphasizing systems of care, hope, and recovery. T 9. A mentally healthy community ensures ready access to routine, urgent, and emergency care for mental health and substance abuse services. T 10. A mentally healthy community provides training for support network members in the community, inclusive of non-professionals and the faith community.

* The Crisis Intervention Team (CIT) is a joint program of the Austin Police Department (APD) and the Travis County Sheriff’s Office (TCSO). The CIT is charged with responding to calls involving people with mental illness, following up with mental health consumers after their initial contact with law enforcement through phone calls and home visits, transporting patients to mental health facilities across the state, and training officers locally and across the state. The CIT is housed at the Austin State Hospital and is staffed by 9 full-time sheriff’s deputies and 6 full-time APD officers. An additional 150 APD officers are designated as mental health officers. Each of these officers receives 40 hours of CIT Training (basic mental health peace officer certification). All TCSO deputies have received 8 hours of mental health training and some deputies have attended an additional 40-hour mental health certification training.

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One additional criterion was added as a result of public input:
T 11. A healthy community strengthens and expands the continuity of affordable services available for those who do not meet the criteria for the three mental health target populations (e.g. time-out services, medications, case management, follow-up care).

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Housing Subcommittee
The Past
Positive Changes
Training: More training is now provided to mental health deputies. Resources: Housing Authorities are now partnering with the Austin Travis County Mental Health

Mental Retardation Center to apply for funding to assist mentally disadvantaged clients.
Attitudes: The community is more aware of affordable housing needs and of the benefits of

independence for those with mental illness.
Programs: The Austin Travis County Mental Health Mental Retardation Center started building its own

housing units in 1986. Mental health housing units are now better integrated with other types of housing. Consumers have more independent living arrangements available and more diverse housing options, with down payment assistance available to make home ownership possible. Collaboration to provide housing among developers and housing agencies is better. Negative Changes and Causes for Concern The housing subcommittee does not believe that Austin has adapted to the changes that have occurred in the area of housing for the mentally ill compared to other communities that have more progressive housing practices.
Resources: The burden of paying for housing has shifted from state and federal governments to the

local level. Federal subsidies are still available, but their future is uncertain. For consumers, income levels have not kept up with rising housing costs.
Attitudes: More understanding and tolerance is needed among housing providers and consumers. While the community is more aware of housing needs for individuals than in the past, more community education is still needed. Programs: Participants have mixed views on whether the availability of housing is sufficient to meet the

need. Some participants indicate that the overall need for housing has been fairly consistent (although a greater percentage of the people who need housing have a diagnosis other than bipolar disorder, schizophrenia, and severe clinical depression so are not likely to receive support and treatment services through state funds), but the mix (but not necessarily the quantity) of housing options needs to change. Other participants cite growing needs, including needs for permanent and supportive housing services, transitional housing, housing that is more affordable than what is now available, and a broader spectrum of services to serve those in housing, and more prevention services. Participants acknowledge that data systems are needed to track what housing is available to quantify the gap.

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The Present
Strengths
Infrastructure: Participants believe that Austin has a greater variety of housing in better locations

relative to other communities. Housing in this community includes co-ops, single room occupancy (SRO) units, U.S. Department of Housing and Urban Development (HUD) 811 housing for persons with disabilities, group homes, Section 8 vouchers, affordable multi-family units, and support for homeownership.
Resources: Local decisionmakers, particularly the City of Austin and the Austin Travis County Mental

Health Mental Retardation Center, are supportive of investments in affordable housing. More sources of funds for housing are available for people with mental health issues than a decade ago.
Attitudes: The Austin community is more aware and more supportive of affordable housing than other

communities. The Austin Travis County Mental Health Mental Retardation Center has a commitment to making housing a priority. Many entities in the community are strongly committed to serving individuals who are homeless or in transition, including City Council, County Commissioners, City and County Housing Authorities, and advocacy agencies like Homes of Your Own (HOYO), Austin Tenants’ Council (ATC), ADAPT, the New Milestones Foundation, and the Austin Travis County Mental Health Mental Retardation Center Board of Trustees.
Programs: Landlord outreach by the Housing Authority of the City of Austin (HACA) is cited as a

strength. HACA has a staff person who conducts outreach activities, including newsletters, with local landlords in an effort to broaden options for those eligible for Section 8 housing. HACA also recognizes the responsibility and accountability of landlords and tenants and has communicated an expectation that the individual’s use of public housing is temporary in order to promote self-sufficiency. The Travis County Housing Authority works with individuals and families to transition from multi-family housing to home ownership through the Section 8 program. Support for staying in housing is provided by Meals on Wheels, home health care, caseworker care, and various HUD voucher programs. The entities in the community that are responsible for these strengths include, but are not limited to: City of Austin Travis County Housing Authority Housing Authority of the City of Austin Austin Travis County Mental Health Mental Retardation Center Mary Lee Foundation Volunteers of America Texas Austin Tenants Council Foundation Communities Community Partners for the Homeless Community housing development organizations
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Caritas SafePlace Lifeworks Legal Aid Advocacy Inc. Family Eldercare Austin Resource Center for Independent Living (ARCIL) Community Action Network (CAN) Texas Department of Housing and Community Affairs Habitat For Humanity
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Texas Workforce Commission (Civil Rights Division) Challenges and Gaps

Homes of Your Own (HOYO) Churches

The majority of the gaps identified are services and strategies that Austin does not have or is not implementing in a consistent way across the community. Challenges for housing providers, advocates, and consumers include but are not limited to:
Infrastructure: Participants have mixed views on the availability of housing. While participants indicate

that Austin has a good variety of housing options, additional needs are cited, including more affordable housing options, especially for individuals at very low levels of poverty (0-50 percent of medium income), with mortgage or rent payments set at 30 percent of the resident’s income. Low- or no-interest loans are needed to encourage builders and developers to build more low-income housing, including needed transitional housing. Entities in addition to the Austin Travis County Mental Health Mental Retardation Center need to share the responsibility for providing housing and support services to persons with mental illnesses.
Policies: HB 2292 creates barriers with a prohibition against using state funds to provide support and

treatment services to people with mental illnesses other than schizophrenia, bipolar disorder and clinically severe depression. Other regulations and practices that keep people out of housing, such as credit history or criminal history, have a particularly negative impact on individuals with mental illness.
Training: Consumer education is not working well. Specifically, consumers have a lack of knowledge of

tenants’ rights.
Resources: Participants are concerned that mental health funds are used for emergency services, not

for prevention. Funds to rehabilitate existing housing stock are insufficient and creative financing and commitments from commercial lenders are needed.
Attitudes: Landlords have difficulty recognizing the accommodations that are necessary for individuals

with a mental illness and the lack of compliance with fair housing laws. The inherent tension between the dual role of the landlord who is also serving as a service provider makes it difficult for some providers to hold tenants accountable for property destruction. The “not in my backyard” (NIMBY) phenomenon impacts the ability to locate housing throughout the community. Support by the business community is needed to either pay a living wage or contribute to meeting housing needs in this community where housing costs are especially high. Consumers may deny having a mental health disorder.
Programs: Challenges and gaps fall into several categories, including:

Unrecognized opportunities. For example, providers did not make use of the Resolution Trust Corporation, refinancing HUD properties, Earned Income Tax Credits, etc. Access and demand. Barriers to access include the paperwork for consumers and difficulty navigating the housing system. Clients are aging out or being bought out by conversion of the property by the landlord.
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Basic needs and support services. More assistance and resources are needed for individuals who need more intensive support such as assertive community treatment programs and intensive case management. Consumers have a greater need for support services than there are services available; in particular, emergency rent assistance is insufficient. Data. There is a need to quantify the need for housing by using accurate data showing the number of units available and the number of persons with mental illness who require housing. Compliance. Because the demand for housing is so great, some compliance issues are overlooked in order to keep people in housing, with the result that, in some cases, consumers live in sub-standard housing. Better compliance and enforcement of housing laws is needed to ensure that no one lives in substandard housing. Those responsible for filling these gaps include, but are not limited to: All the same agencies listed in the strengths section above, plus: Salvation Army Banking and lending community Private business community

The Future
Working in two groups, with one group drawing their vision of the future and one group using building blocks and other three-dimensional objects to depict their vision of the future, participants envision a future that has the many interesting characteristics. The group presenting their vision in a visual format created the following vision: Integrated community Single family homes, condos, and one-story housing All basic needs within walking distance Facility with educational classes Bus stops Legal assistance located within the community School Coffee shops Security Pharmacy Churches Doctors’ offices Green space, exercise trails Pets

The group working on a three-dimensional scale created a model with the following characteristics: Single room, multi-family, duplexes, high-rise housing Mixed income housing Pharmacy Commercial district
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Movie theatre Community center Wildlife preserve Park Telecommunications tower for internet access
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Hospital School Daycare Americans with Disabilities Act (ADA) accessibility

No law enforcement No eligibility requirements Options for multi-generational or like age living

Criteria for a Mentally Healthy Community
Participants were organized into three groups, with each selecting criteria for two of the six categories (infrastructure, resources, policies, programs, training, and attitudes) and developing criteria in each category. The groups were then instructed to utilize the following guidelines in prioritizing their top three choices in each of the six categories: At least one of the criteria must be cost-neutral; Must be feasible and measurable; Must have significant impact; Reflects evidence-based or best practices; Is innovative/creative/out-of-the-box thinking; Addresses an identified gap. Each of the groups then presented their top three choices to the whole group and explained why they had prioritized those criteria. The members of the group were each given six votes to cast for those criteria they believed were most important, with the objective of identifying the top twelve criteria. After discussion and some consolidation, 11 criteria resulted and are listed below in priority order:
H 1. A mentally healthy community has supportive case management available upon request which would prevent housing loss and access basic, emergency needs, such as emergency rental assistance, food, clothing, counseling, healthcare, shelter, utility assistance, down payment assistance, and transportation. H 2. A mentally healthy community observes housing laws and rights for those with mental illness and integrates individuals with a mental illness into the larger community. H 3. A mentally healthy community has data-driven systems to improve access to available housing options. H 4. A mentally healthy community has training for all consumers, family members, and other stakeholders on local, state, and federal laws and responsibilities. H 5. A mentally healthy community has a comprehensive city-wide housing plan which incorporates the needs of special housing groups. H 6. A mentally healthy community has mandatory training for housing providers, bankers, lenders, developers, and others on the housing needs and rights of individuals with mental disabilities. H 7. A mentally healthy community has sufficient, safe, affordable, accessible, and integrated housing units.

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H 8. A mentally healthy community has a policy of inclusionary zoning, such as requiring builders to construct a percentage of affordable housing units in their developments or pay into the housing trust fund for affordable housing. (Inclusionary zoning may not be legal in the state of Texas. There will need to be further discussion and a definition created for inclusionary zoning before work begins on this criterion.) H 9. A mentally healthy community treats all individuals with dignity and respect. H 10. A mentally healthy community has training on how to access funds to build, own, or modify housing and to access rental assistance. H 11. A mentally healthy community has resources to hold people and providers accountable for violating fair housing and the Americans with Disabilities Act (ADA).

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Education and Community Awareness Subcommittee
The Past
Changes from the past include the following:
Infrastructure: Technology now allows more effective communication strategies and has been used to

enhance crisis services.
Resources: Despite deinstitutionalization, money has not followed patients with mental illness into the

community. More supports are needed to allow people to take advantage of the community-based programs. Some limited insurance coverage is now available for mental health disorders.
Attitudes: Although the stigma of mental illness was more pervasive twenty years ago, it persists today.

Education and knowledge are now available to understand the biological component of mental illness and health and advances in mental health treatment. New language is now used, i.e., “living with a mental illness or brain disorder,” rather than to “have a mental illness.” Public perception has changed somewhat as a result of mainstream movies and television shows that feature positive images of persons with mental health disorders. Recovery is now part of the mental health vocabulary. The community is more aware of the collateral effects of poor mental health delivery systems, i.e., substance abuse, criminal activity and incarceration, homelessness, and absenteeism in the workforce. The community is now holding those who serve people with mentally illness accountable, such as law enforcement and mental health centers. Consumers now need more education about treatment options, self-advocacy, and how to be involved in their own treatment.
Programs: People with mental illness used to be warehoused in institutions, but community-based

services to consumers now include professional, peer, and para-professional support. While consumers depend on this support, not enough is available. Consumers are engaged in their own recovery through networks, hotlines, and support groups. Consumers now benefit from more culturally competent services. Schools now have trained professionals to address mental illness in children. More and better medications with fewer side effects are available, but money to support these programs is often lacking. Negative changes include the fact that fewer families are intact, making family support more difficult. Society is more hectic, which makes it more difficult for consumers to achieve self-sufficiency and to have the community and family supports they need. A number of new services are available but they are not effectively coordinated, so accessing services has become very complicated. Funding reductions are at least partially responsible for shorter term treatment models and the rationing of care. Jails are now warehousing people.
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The Present
Strengths
Infrastructure: Austin is a highly educated community that is receptive to innovative services and

resources. The professional community has a tremendous amount of talent and education and there are strong research and educational institutions (although they are not used for education and awareness). Agencies, providers, and consumers collaborate well and have a tradition of partnering to achieve goals. The communities of interest in health and human services that are willing to work together include the United Way, Austin Area Human Services, Advocacy Inc., public relations firms, President Faulkner’s new initiative at The University of Texas, the New Milestones Foundation, and Texas Appleseed. A number of grass roots organizations are involved in mental health services as well as school and business partnerships and the faith community. The Austin Travis County Mental Health Mental Retardation Center provides mental health and substance abuse services together and is strongly supported by local governments. The Center also funds a public information officer, a Public Relations Board committee, and multiple strategies to inform the public.
Resources: Businesses and foundations in the community are willing to invest in the community. Attitudes: Evidence of positive attitudes toward mental illness include some positive media exposure,

an emphasis on eradicating the stigma of mental illness as outlined in the New Freedom Commission on Mental Health, a community that values multi-cultural diversity, local community leaders who are interested in mental health, and a growing acceptance of recovery. Positive attitudes are promoted by the Austin Travis County Mental Health Mental Retardation Center, which values public relations. Close proximity to the state legislature provides an opportunity to educate legislators about mental health.
Programs: The community has excellent consumer involvement, particularly through the Self-Help

Advocacy Center, Texas Federation of Families for Children’s Mental Health, Mental Health Association of Texas, strong advocacy groups, and a growing number of consumer and family support groups which could promote increased advocacy, such as the National Alliance for the Mentally Ill (Austin Chapter), Depression and Bipolar Support Alliance (DBSA), Texas Mental Health Consumers (TMHC) and the Austin Travis County Mental Health Mental Retardation Center. Some faith-based organizations are currently providing mental health support services. The Austin Travis County Mental Health Mental Retardation Center and local public housing authorities are undertaking a collaborative housing initiative. Consumers have access to more effective medications that reduce symptoms. The Austin Travis County Mental Health Mental Retardation Center as well as other organizations sponsor and promote frequent publications, community forums, and varied media exposure through radio, articles, and television news coverage.

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The entities in the community that are responsible for these strengths include but are not limited to: Austin Travis County Mental Health Mental Retardation Center Hogg Foundation for Mental Health City of Austin Health and Human Services Department Consumer Groups –National Alliance for the Mentally Ill (Austin Chapter), Texas Federation of Families for Children’s Mental Health, Texas Mental Health Consumers (TMHC), Self-Help Advocacy Center (SHAC) Challenges and Gaps The majority of the gaps identified are services and strategies that Austin does not have or is not implementing in a consistent way across the community. The following services were highlighted in the discussion:
Infrastructure: While participants spoke highly of the level of collaboration and coordination between

Travis County Health and Human Services Department and Veterans Services Community Action Network Mental Health Association of Texas Center for Public Policy Priorities Faith-based organizations Local news media

the agencies involved in providing mental health services and supports, not everyone in the subcommittee agrees with that assessment. Some participants acknowledge that although a number of organizations try to fill the gaps in services, better coordination is needed to address education and awareness. Other participants are very critical of the level of coordination and suggest that many agencies compete without working together.
Policies: Participants are concerned that mental health issues compete for air time and attention with

other pressing concerns. Participants expressed frustration that mental health is difficult to define in understandable terms. The implementation of HB 2292 by the Texas legislature is considered by participants to be problematic. The new eligibility requirements of HB 2292, passed by the Texas Legislature effective September 1, 2004, effectively limit services provided by local mental health authorities to individuals diagnosed with one of three disorders: bipolar disorder, schizophrenia, or clinically severe depression (for adults only, the target population for children was not changed, although the target population now refers to children with “severe emotional illness” rather than “severe emotional disturbance”). In addition to denying services to many other individuals with conditions that are treatable and have a high rate of recovery, Task Force participants believe that this use of diagnostic category rather than functional ability to determine service eligibility promotes stigmatization. The new law also requires that a disease management approach be used to treat the three priority disorders, which may result in funds being expended on the first individuals to walk in the door, with little or no funding left for others with the same diagnosis. HB 2292 eliminates therapy provided by psychologists, licensed professional counselors, licensed marriage and family therapists, and social workers to adults under Medicaid. Only psychiatrists are funded under Medicaid, and their services consist primarily of medication management, not counseling. Along with budget cuts to

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local mental health authorities, the effect of these legislative changes is to limit access to services and place the burden of care on local communities.
Training: More training and education about mental health is needed, particularly for the faith community, consumers, school clubs and civic organizations, employers, businesses, law enforcement officers, primary care physicians, nurse practitioners, and other primary care providers. Funders and the community need to be educated about successes and best practices (e.g. combining medication and psychotherapy) to draw resources to those areas.

Consumers often lack clear information about mental health and may have difficulty obtaining information about available services. Consumers may lack knowledge about how to access the system, how to advocate for mental health benefits coverage, and how to deal with discrimination.
Resources: Mental health services are spread thin and resources are diminishing. Funding for

education and awareness issues is insufficient. Additional funding is needed for a wellness approach to mental health. Insurance parity between physical and mental health is largely absent.
Attitudes: The stigma of mental illness persists (e.g. discrimination in employment and insurance,

avoiding treatment because of stigma). Consumers facing stigma may avoid self-advocacy and fear speaking up about their mental health needs. While participants acknowledged that there is some positive media exposure, media publicity about mental health is primarily negative. It is difficult to convince the public to identify mental health as a priority, and the lack of positive public service announcements about mental health reflect a lack of public interest. The public needs to understand that mental illness is treatable and that recovery is possible.
Programs: Challenges fall into the following categories:

Access: There are weak access portals (e.g. people go to their family doctor or pastor, who may not be well-informed about mental health issues). Access to mental health services for the uninsured is limited and communication to this group is minimal. Long waiting lists and restrictive eligibility for services are barriers to accessing service. Diagnostic categories, not functional abilities, have to be used to access services, which promotes stigmatization (see information about HB 2292 on the previous page). Access to emergency/crisis mental health services, especially residential services, is limited. Access to medications is limited, especially new generation medications. Consumers have difficulty finding an appropriate provider, and the providers need training. Paperwork is too complicated. Consumer advocacy: An ombudsman is needed to assist consumers in navigating the mental health system. A network of peer coaches is also needed. School-based services: Within the education system, there are not enough services, existing services are hard to access, and coordination needs to be improved. More mental health programs are needed in schools and universities. Prevention: More prevention programming is needed, specifically activities and services that promote resiliency, reduce risk, and reduce the expression and impact of mental illness. Participants further defined prevention as a strategy to establish an environment to abate mental illness. As a result of a lack of focus
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on prevention, providers intervene later in the course of a mental illness. More teacher involvement is needed, as they are the gatekeepers for identifying students to enter the mental health system. Cultural issues: Migrant and immigrant populations present unique issues that are not adequately addressed (e.g. language, poverty, fear of being turned in to immigration authorities). More information is needed that is linguistically, ethnically, and culturally appropriate. Not enough practitioners are culturally competent. Best practices: Too few programs are evidence-based and/or based on best practices. Inadequate resources prevent the collection and analysis of data and it is agreed that more quantitative data and more consistent data about programs are needed, including indicators that measure program effectiveness and impact. Suicide prevention: Austin has one of the highest suicide rates in Texas. Suicide education/prevention messages should be visible in the media, business community, schools, and senior citizen groups. Hotlines: Better emphasis is needed on hotlines and promotion of the hotline numbers in the city and universities. Basic needs: Consumers need more information about how to access housing resources and need more basic needs support, such as money, housing, transportation, and food. Media relations: A set of guidelines is needed that includes people-friendly language for the media to use when reporting mental health stories. Austin does not have:
Policies: Training:

Services that do not work well:

Attitudes: Programs:

A clear definition of mental health and mental illness. Professional education for best practices and a system for adhering to best practices. Education of the media. Promotion of a sense of community within the city. A strategic messaging campaign about mental health, healthy lifestyles, and a continuum of services ranging from prevention to hospitalization.

Education of families and consumers regarding what to expect from providers.

Hotline. The location of the Psychiatric Emergency Services unit is not well known.

The services that the community needs more of include:
Infrastructure: More collaboration among agencies, providers, and consumers.

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consumers about how to access medication and services.
Programs: More and better efforts within the minority community. A more consistent and clearer

media message about mental health. Those responsible for filling these gaps include, but are not limited to: All of us Government Institutions Medical profession Faith-based communities Schools Business and industry Professional Provider Organizations and Associations Law enforcement Media leadership Mayor’s Office Providers

The Future
Working in three groups, with one group writing their vision of the future, one group drawing their vision of the future, and one group using building blocks and other three-dimensional objects to depict their vision of the future, participants envision a future that has many interesting characteristics. The group describing their vision with words produced the following work: Everyone would have a home and a job and live the American dream; Mental illnesses would be treated and accepted on the same level as physical illness; A Lance Armstrong figure would come forward on behalf of mental illnesses and people would vie to be spokespersons for the cause; Scientific breakthroughs would eradicate brain disorders; Stem cell research and human genome research will shed new light on brain disorders; The war on substance use disorders will be won; Jails and prisons will be replaced with hospital beds, school classrooms, and community treatment and support; There will be unlimited and accountable resources for mental health; There will be an overarching system headed by a mental health czar incorporating self-determination, funding and access, evidence-based research and treatment, wrap-around services, and the input and participation of consumers, family members, and other stakeholders. The group presenting their vision in a visual format created a mandala representing the larger social and economic environment, with the client at the center, surrounded by non-traditional services. Also represented are the following elements: Comprehensive assessment and diagnosis, including functional assessments; Multiple entry points; Integration of physical and mental health; A community that offers support and advocacy;
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Connections to employers and businesses; Churches and other faith-based organizations are an integral part of the support network; Alternative therapies are considered a valid strategy; Case management is comprehensive and individualized; Adequate training and support exists for professionals; Services are portable from one community to another; Access to medication is streamlined; Consumers move from the center to outside support networks with treatment progress. The group working on a three-dimensional scale created a model with the following characteristics: An outer circle represents coordination of care; A Lance Armstrong figure is present as the mental health champion; A house represents basic needs being met; The consumer occupies a central position representing client-centered care that is linked and coordinated; Support groups and families are an important part of the circle; There is an active safety net that actually works; Transportation is provided.

Criteria for a Mentally Healthy Community
Participants were organized into three groups, with each selecting criteria for two of the six categories (infrastructure, resources, policies, programs, training, and attitudes) and developing criteria in each category. The groups were then instructed to utilize the following guidelines in prioritizing their top three choices in each of the six categories: At least one of the criteria must be cost-neutral; Must be feasible and measurable; Must have significant impact; Reflects evidence-based or best practices; Is innovative/creative/out-of-the-box thinking; Addresses an identified gap. Each of the groups then presented their top three choices to the whole group and explained why they had prioritized those criteria. The members of the group were each given six votes to cast for those criteria they believed were most important, with the objective of identifying the top twelve criteria. The 12 resulting criteria are listed below in priority order:
E 1. A mentally healthy community utilizes social clubs, professional organizations, support groups, neighborhood groups, and faith-based communities as vehicles for community mental health education. E 2. A mentally healthy community has a broad-based, community-wide structure to carry on the work of the Mental Health Task Force’s education and awareness campaign.

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E 3. A mentally healthy community communicates with the public, the faith-based community, and the media about the treatability of mental illness and the high success rates of various treatment modalities in a linguistically, ethnically, and culturally appropriate manner. E 4. A mentally healthy community provides evidence-based, culturally appropriate mental health training for those who work with older adults, teens, substance abusers, people with co-occurring disorders, and people with developmental disabilities. E 5. A mentally healthy community reviews linguistically and culturally competent models of best practice programs in its own and other communities and works toward replication, including on-going aggressive outreach to underserved populations. E 6. A mentally healthy community ensures that policymakers understand the positive fiscal impact of prevention and treatment. E 7. A mentally healthy community develops and implements an effective mental and physical wellness communication plan targeted at the general public. E 8. A mentally healthy community maintains a culturally appropriate community suicide prevention plan that has the approval and support of the Mayor’s Office, the City Council, and the County Commissioners. E 9. A mentally healthy community designates a staff member or department at the Austin Chamber of Commerce that is responsible for educating employers about the continuum of mental health from health to illness in order to increase productivity and decrease health care services required. E 10. A mentally healthy community includes mental health education in primary, secondary, and post-secondary school curricula and to first responders, including police and emergency medical technicians. E 11. A mentally healthy community ensures that schools teach students and teachers to value and appreciate individual differences and lifestyle choices, including both mental and physical health conditions. E 12. A mentally healthy community creates a Partners in Education* program focused on mental health issues.

* Partners in Education is a program of the Austin Independent School District (AISD) designed “to create and foster effective community school partnerships that support and enrich student learning and success.” The program encourages businesses, individuals, and community organizations to get involved in AISD schools.

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Appendix B: Participants
Co-Chairs Former State Representative Wilhelmina Delco and Former Mayor Gus Garcia Mental Health Task Force Planning Team Chief Michael McDonald (Lead), King Davis, David Evans, Lynda Frost, Janice Kinchion, David Lurie, Reymundo Rodriguez, and Mildred Vuris. Support Staff Ralph Gohring and Elizabeth Phillips (facilitators), Joe Silva, Kimberly Freeman, Richard Wallace, and Willie Williams. Housing Subcommittee
Participant Vicki Covington Pennington Davis Jim Hargrove Aaryce Hayes Dr. Patrick H. Herndon Paul Hilgers Kelli Howard Barbara Humphrey Bobbi Leverich Michelle Peralez Wenceslao D. Santiago Dorcas Seals JoEllen Smith Kathy Stark Helen Varty Mildred C. Vuris Organization Texas Workforce Commission, Civil Rights Division Public Member Housing Authority of the City of Austin Advocacy Incorporated Citizen advisory committees, Austin Travis County Mental Health Mental Retardation Center City of Austin Neighborhood Housing and Community Development Texas Rio Grande Legal Aid Travis County Housing Authority Austin Travis County Mental Health Mental Retardation Center Travis County Housing Authority Housing Authority of the City of Austin Austin Travis County Mental Health Mental Retardation Center Diana McIver and Associates Austin Tenants Council Front Steps Director of Governmental and Community Relations, Austin Travis County Mental Health Mental Retardation Center

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Education and Community Awareness Subcommittee
Participant Lydia Graciela Agraz Shannon Carr Joe C. Colvin, Ed.D. Betty Jo Crayton Exalton Delco Larry L. Earvin Bonny Gardner, Ph.D. Donetta Goodall Irene Guzman Pennie Hall Ginger Hampton Merily H. Keller Robert Mendoza Manuel Renteria Reymundo Rodriguez Beverly Scarborough Ollie J. Seay, Ph.D. Clinton Smith Joleen Smith Mildred C. Vuris Joseph D. White, Ph.D. Sam Woollard Organization Vice President, Public and Government Affairs, Time Warner Cable Austin Executive Director of the Self-Help and Advocacy Center (SHAC) Retired, Houston Independent School District, Special Education Department Public Member Board member, Austin Travis County Mental Health Mental Retardation Center Houston-Tillotson College Gray Panthers Austin Community College Partners in Education Education Program Coordinator, National Alliance for the Mentally Ill- Texas Citizen advisory committee member, Austin Travis County Mental Health Mental Retardation Center Co-chair, Texas Suicide Prevention Community Network and Texas Suicide Prevention Partnership Austin Partners in Education Austin Police Department Executive Associate, Hogg Foundation for Mental Health Austin Travis County Mental Health Mental Retardation Center Psychologist, Masters in Health Psychology Program, Texas State University-San Marcos, Texas Psychological Association, Public Policy Chair, Texas Association on Mental Retardation, Board Member Co-convener, Gray Panthers Austin Texas Mental Health Consumers Director of Governmental and Community Relations, Austin Travis County Mental Health Mental Retardation Center Licensed psychologist in private practice and Director of Catholic Family Counseling and Family Life, Diocese of Austin Associate Director, Community Action Network

Justice Systems Subcommittee
Participant Judge Michael A. Coffey Robert Dahlstrom Claire Dawson-Brown Honorable David Escamilla Eric Frey, PhD. Psy. Raman Gill Barry Hall Genevieve T. Hearon Honorable Guy Herman Dr. Patrick H. Herndon Honorable Nancy Hohengarten Sgt. Darren Long Abraham Minjarez, LPC, MBA Beth Mitchell Organization City of Austin, Downtown Austin Community Court Austin Police Department Travis County District Attorney’s Office Travis County Attorney, United Way Travis County Juvenile Probation Department Attorney, Texas Appleseed Austin National Association for the Advancement of Colored People Austin Travis County Mental Health Mental Retardation Center Trustee and President and Executive Director of Capacity for Justice Judge, Travis County Probate Court Citizen advisory committees, Austin Travis County Mental Health Mental Retardation Center Judge, Travis County Court at Law 5 Travis County Sheriff’s Office. Crisis Intervention Team. Assistant Director, Austin Travis County Mental Health Mental Retardation Center Advocacy Incorporated, Senior Managing Attorney
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Participant Sue Mueller John Oliver Chris Perkins John Posey Ivie Rich David Allan Smith Sgt. Todd Smith Mike Summers RN, MSN Mildred C. Vuris Jamie Watson Carolyn Young Organization Adult Probation Public Member Austin Police Department Travis County Juvenile Probation Baptist Ministers Union Austin City Attorney Austin Police Department, Crisis Intervention Team Travis County Sheriff’s Office Director, Inmate Medical Services Director of Governmental and Community Relations, Austin Travis County Mental Health Mental Retardation Center Travis County Juvenile Probation Hogg Foundation for Mental Health

Short- and Long-Term Treatment Subcommittee
Participant Charlotte Brooks Andrea Colunga Bussey H. Ed Calahan Cecile DeWitt-Morette David Evans John Gilvar Monique Glover Mike Halligan Linda Herbert, LPC Dr. Patrick H. Herndon Princess Katana David Lurie Martha Martinez Katy McElroy Clifford Moy, M.D. Keith Morris Jefferson Nelson, M.D. Melody Palmer-Arizola Chris Perkins Pamela Schott, LCSW Sgt. Todd Smith Rosalind Smith-Jones Armin Steege Mildred C. Vuris Donald Zappone, Dr. P.H. Organization Travis County Health and Human Services and Veterans Services Travis County Health and Human Services and Veterans Services Pastor, Agape Baptist Church Professor Emerita, University of Texas and Citizens' Planning Advisory Committee member, Austin Travis County Mental Health Mental Retardation Center Executive Director, Austin Travis County Mental Health Mental Retardation Center Health Care for the Homeless Project Director, Austin-Travis County Community Health Centers Austin Travis County Mental Health Mental Retardation Center Texas Mental Health Consumers Sexual Assault Counseling Director, Safeplace Mayor’s ADA, Citizen advisory committees, Austin Travis County Mental Health Mental Retardation Center Children’s Partnership Executive Director, Austin/Travis County Health and Human Services Department Board member, Austin Travis County Mental Health Mental Retardation Center Austin Travis County Mental Health Mental Retardation Center Austin State Hospital Austin Travis County Mental Health Mental Retardation Center Psychiatrist Austin Travis County Mental Health Mental Retardation Center Austin Police Department Clinical Director, YWCA of Greater Austin Austin Police Department, Crisis Intervention Team Public Member Administrator and Vice President, Seton Shoal Creek Hospital Director of Governmental and Community Relations, Austin Travis County Mental Health Mental Retardation Center Executive Director, Austin Child Guidance Center

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Appendix C: Action Plan Detail
Attached are the Excel spreadsheets containing the detailed tasks for accomplishing the action plan.

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Criteria 01. A mentally healthy community has 24-hour psychiatric emergency beds in local hospitals. Task 1. Conduct survey to determine psychiatric emergency bed projected need for years 2006, 2010, 2015 and 2020; report findings to Travis County Hospital District Board of Directors. Who? Hospital District Executive Director

2. Prepare and recommend detailed action response to provide psychiatric emergency beds Hospital District-Board of Directors as projected by needs survey; proposed plan to include proposed locations and number of Travis County Commissioners Court beds allocated to public and private providers; present plan to stakeholders and community. City of Austin Austin Tenants CouncilMHMR Community 02. A mentally healthy community is willing to provide adequate resources and funding for all aspects of the mental health system. 3. Implementation of plan, including funding resources. 1. Develop assessment of current and projected MH/MR funding needs for triage/diversion and crisis stabilization unit. 2. Identification and selection of champion(s) to coordinate advocacy and effective actions among MH/MR community and stakeholders with ultimate mission to obtain adequate funding for the mental health system. Private and public hospital providers Austin Tenants CouncilMHMR Hospital District Criminal District Community Judges MH/MR Community Law Enforcement Prosecutors Austin Tenants CouncilMHMR

3. Development of coordinated funding plan for inclusion in respective governmental agency Champions and departmental budget requests for consideration by local government funding authorities local government (City, County, Hospital District) in compliance with respective budgetary guidelines and Agencies and department timelines 4. Coordination of education and advocacy efforts by stakeholders in support of respective budget requests before local governmental funding authorities. 5. Approval of fiscal year budgets providing adequate resources for MH/MR Champions Stakeholders Respective governmental agencies Local government System funding authorities

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Criteria 03. A mentally healthy community has a pre-booking system for adults and juveniles with the authority to divert and provide appropriate services. This system is created by a committee that includes representatives from the Austin Travis County Mental Health Mental Retardation Center, law enforcement, judicial, legal, medical, social workers, and mental health consumers. Task 1. Set up working group of above representatives to ensure all appropriate diversion systems are in place at booking at downtown jail and juvenile facilities. 2. Develop systems to respond to need 3. Obtain “buy in” for proposed systems of working group organizations and Travis County Commissioners Court, City of Austin and the community. 4. Implement plan developed above. 5. Measure the above activity to see if there has been a reduction of persons with mental illness in criminal justice system and more receiving services. 1. Survey current training resources and programs. 2. Form steering committee for MH education in Travis County. Who? Mental Health Task Force working in conjunction with Jail Overcrowding Task Force (JOTF) Mental Health Task Force working group in conjunction with JOTF Mental Health Task Force working group in conjunction with JOTF Mental Health Task Force working group in conjunction with JOTF Mental Health Task Force working group in conjunction with JOTF Task force staff member Mayor’s Task Force Representative Travis County Representative Steering committee member Steering Committee

04. A mentally healthy community has training available for specialists working in the system, such as corrections, defense lawyers, prosecutors, criminal judges, probation, Crisis Intervention Team, and any other relevant law enforcement agencies, resulting in 3. Survey and determine best practices of related MH training better interactions with relevant stakeholders and persons with 4. Determine appropriate MH training to fill in current gaps to ensure best practices in mental illness in the system. training available to above group. (corrections, defense lawyers, etc.)

5. Develop and recommend on-going training responsibilities to ensure best practices and sustainability. 6. Assign on-going training responsibility. 05. A mentally healthy community has policies that set the standard 1. Review existing policies between agencies that are not being enforced. of care for people with mental illness, such as jail diversion 2. Survey and establish best practices in detention and diversion programs. programs. 3. Develop policies/community plan for implementation of best practices. 4. Assign monitoring committee of Mayor’s task force to champion implementation of policies.

Steering Committee Department heads of City, County, State Policy Committees and stakeholders Policy Committee Policy Committee Mayor’s task force committee

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Task 1. Identify and engage high officials in agencies that have information that should be shared. 2. Determine what information is available from each agency. 3. Determine what information may or may not be shared and overcome obstacles/misunderstandings/legal impediments and establish on-going policies. 07. A mentally healthy community has mental health criminal justice 1. Planning meeting of representatives with decision making and financial authority that includes judges, prosecutors, defense attorneys, probation (adult and juvenile), MHMR, and diversion programs. hospital district, community health care clinics, law enforcement. 2. Develop or select a uniform assessment tool that is culturally competent and identifies persons with behavioral health disorders and potential appropriate diversion programs. 3. Develop psychiatric ER or triage center to assess people. 4. Develop program eligibility criteria. 5. Identify existing programs and develop new programs to which persons can be diverted for treatment and intervention. 1. Planning meeting of relevant stakeholders to identify specific dual diagnosis treatment 08. A mentally healthy community has adequate inpatient and outpatient dual diagnosis treatment for substance abuse and mental needs and resources. health disorders for adults and juveniles. Criteria 06. A mentally healthy community has policies that support the sharing of information between agencies within federal and state guidelines. Who? Mayor’s task force information committee Mayor’s task force information committee Mayor’s task force information committee Consumers and advocates

Team of psychiatrist, psychologist, social workers with expertise in child and adult assessment. Federally qualified healthcare clinicsHospital District Stakeholders identified above StakeholdersMHMR Austin Tenants CouncilMHMR ASH Hospital District Federally qualified health clinic Crisis Intervention Team Mental Health and Substance Abuse Treatment Consumers Advocates MHA Hospital District Jail Psychiatric Care Juvenile Justice System Same as above Same as above

2. Research evidence based, culturally competent best practices 3. Develop evidence-based treatment programs to meet identified needs.

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Criteria 09. A mentally healthy community has a post-booking mental health and mental retardation docket for adults and juveniles with special training in mental health and mental retardation and related legal issues for all participants. Task 1. Develop a division of district attorney’s and county attorney’s office staffed with prosecutors specially trained and sensitive to mental health issues. 2. Develop a division of juvenile public defenders office staffed with specially trained attorneys and social workers. 3. Develop a mental health public defenders office, or equivalent, staffed with specially trained attorneys and social workers who work together as a defense team. Who? District Attorney County Attorney District Courts in conjunction with Juvenile Public Defenders Stakeholders Criminal Court Judges Juvenile Public Defender Presiding Criminal Court Judge

4. Develop and implement subset of highly trained judges who dedicate a portion of their weekly docket to mental health cases, or create mental health courts at the felony and misdemeanor levels or a mental health court with jurisdiction over both felonies and misdemeanors. 5. Develop a mental health court liaison program for the district and county courts. 10. A mentally healthy community provides training and education about how the mental health system works and roles of various stakeholders and the legal system process related to persons with mental health issues for the purpose of creating community awareness. 1. Develop multimedia materials to educate above stakeholders about newly developed systems and legal processes for persons with mental health disorders. 2. Develop a series of training events. 3. Start holding training events.

Presiding Criminal Court Judge Advocacy groups Justice system stakeholders Austin Tenants CouncilMHMR Same as above Foundations Advocacy groups

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Criteria 01. A mentally healthy community has at least one Psychiatric Emergency Center in an existing hospital with a detox center attached. Task 1. Review and update existing resources and program models analysis and information. Who? Directors of TCHHS&VS, Austin HHS, Austin Tenants Council, MHMR, Hospital District Directors of TCHHS&VS, Austin HHS, Austin Tenants Council, MHMR, Hospital District Directors of TCHHS&VS, Austin HHS, Austin Tenants Council, MHMR, Hospital District

2. Establish a consensus-building process with stakeholders and in consultation with the hospital district to determine interest and commitment in co-locating a Psychiatric Emergency Center (with a detox center) in an existing hospital. 3. Identify champions and stakeholders to develop an implementation timeline to include cost, identified funders and sustainability projections. MEASURE: Emergency rooms will be used less for non-emergency medical care. 02. A mentally healthy community has access to outpatient services 1. Clarify and develop needed resources for a full range of mental health services and within one week of identified need (i.e., medications, psychotherapy, supports. employee assistance (EAP)-type programs). 2. Establish an urgent care clinic with evening and weekend hours and expand integrated healthcare in existing community primary care clinics. Utilize nurse practitioners/physician assistants to provide care. Use existing primary care/mental health clinics for expanded hours. 3. Expand outpatient mental health capacity to decrease wait times and caseloads.

Directors of TCHHS&VS, Austin HHS, Austin Tenants Council, MHMR, Hospital District, other stakeholders Directors of TCHHS&VS, Austin HHS, Austin Tenants Council, MHMR, Hospital District, other stakeholders Directors of TCHHS&VS, Austin HHS, Austin Tenants CouncilMHMR, Hospital District, other stakeholders

03. A mentally healthy community has short- and long-term residential treatment options based on population needs.

MEASURE: City employees will have insurance and benefits that allow access to outpatient care within one week of identified need. 1. Clarify and assess needs for residential care (e.g. transitional care, halfway houses, ¾ Directors of TCHHS&VS, Austin HHS, Austin houses). Tenants Council, MHMR, other stakeholders 2. Expand and develop transitional care capacity. Directors of TCHHS&VS, Austin HHS, Austin Tenants Council, MHMR, other stakeholders Directors of TCHHS&VS, Austin HHS, Austin Tenants Council, MHMR, other stakeholders

3. Expand independent housing capacity.

MEASURES: 1) Needs report by 2/06 2) Transitional care capacity has expanded. 3) Increase in the number of people that move into non-supervised living situations.

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Criteria 04. A mentally healthy community partners with consumers and families to promote hope, recovery, and self-determination. Task Who? 1. Partner with consumer and family groups to identify needs and models to promote hope, Directors of TCHHS&VS, Austin HHS, Austin resilience, recovery and self-determination. Tenants CouncilMHMR, other stakeholders 2. Expand the use of family partners/parent liaisons for children, adult children (family members) and their families. 3. Implement agreed upon models for promoting hope, resilience, recovery and selfdetermination. 4. Hold annual events such as Celebration of Recovery. Measure: Within 12 months a consumer/family partnership will exist. 1. Using the CIT curriculum and practice standards as a starting point, the CIT Team will hold a conference of all law enforcement agencies operating in Travis County to adopt a common educational curriculum and manual of operating procedures. 2. The CIT Team will lead the development of training based on the adopted curriculum and manual of operating procedures. 3. Increase the number of MH officers to ensure adequate coverage and prompt responsiveness. 1. Assess City/Travis County benefits including employees, MAP and community mental health center recipients to determine current benefit structure related to parity. 2. Identify and mobilize Travis County community and advocacy groups to work within legislative delegation and congressional representatives to promote parity with federal and state funding. 3. Identify and mobilize Travis County community and advocacy groups to work within legislative delegation and congressional representatives to promote parity with private employment benefit services. 07. A mentally healthy community increases awareness that mental health issues affect all of us –“it is us” – and promotes the concept that mentally healthy lifestyles and a mentally healthy community are shared values. 08. A mentally healthy community provides training to promote optimal mental health emphasizing systems of care, hope, and recovery. Directors of TCHHS&VS, Austin HHS, Austin Tenants Council, MHMR, other stakeholders City, County, Austin Tenants Council, MHMR, other Stakeholders City, County, Austin Tenants Council, MHMR, other Stakeholders CIT Leadership

05. A mentally healthy community has a policy to maintain and expand a community practice standard (e.g. practice standards in the Crisis Intervention Team curriculum) across law enforcement and public safety agencies for “crisis intervention” based on a clear understanding of mental illness, the law, and best practice educational curricula.

CIT Leadership CIT Leadership City of Austin and Travis County Human Resource Depts. TMHA, NAMI Texas, Other - TBI

06. A mentally healthy community promotes parity in mental and physical healthcare benefits beginning with City and County employees and extending to enrollees in publicly funded safety-net delivery systems.

Chambers of Commerce

1. Design and support public awareness campaign to promote the above concept, including Director of City of Austin HHS utilizing license plates, billboards, local cable tv channels, an on-going newspaper column of information highlighting prevention, early diagnosis and mentally healthy lifestyles. 1. Utilize existing community planning groups to identify the training content and trainers. 2. Prepare training materials. 3. Identify audiences and provide training. AMHPP and CYMHPP, MHMR AMHPP and CYMHPP, MHMR AMHPP and CYMHPP, MHMR

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Criteria Task 09. A mentally healthy community ensures ready access to routine, 1. Conduct community mapping/needs assessment/resource development and urgent and emergency care for mental health and substance abuse identification of capacity ratios. services. 2. Identify gaps and set priorities for filling gaps, e.g. extended hours, 24 hour physician responsiveness, etc. 3. Explore the feasibility of developing a common process for assessment/intake and a linked system and develop an action plan. Who? Community planning partnerships

Community planning partnerships Executive Directors of ATCMHMR and the Austin/Travis County Health and Human Services Department

4. Seek additional funding to expand Integrated Behavioral Health Programs, i.e., E-Merge (not specified) 10. A mentally healthy community provides training for support network members in the community, inclusive of non-professionals and the faith community. 1. Identify or develop a training curriculum for community and pastoral leaders. AIM, Austin Tenants Council, MHMR, Hogg Foundation, Dean of School of Social Work, Representative of faith-based organizations (e.g. AGAPE Baptist Church AIM, Austin Tenants Council, MHMR, Hogg Foundation, Dean of School of Social Work, rep for faith-based orgs, i.e., AGAPE Baptist Church

2. Offer training sessions to identify and refer persons experiencing mental illness.

3. Offer opportunities to form relationships between treatment staff and the faith community AIM, Austin Tenants Council, MHMR, Hogg to refer people for church-based care services. Foundation, Dean of School of Social Work, rep for faith-based orgs, i.e., AGAPE Baptist Church 4. Offer annual conference to promote these training opportunities, using the Central Texas AIM, Austin Tenants Council, MHMR, Hogg African American Family Support Conference as an example. Foundation, Dean of School of Social Work, rep for faith-based orgs, i.e., AGAPE Baptist Church 5. Track progress. AIM, Austin Tenants Council, MHMR, Hogg Foundation, Dean of School of Social Work, rep for faith-based orgs, i.e., AGAPE Baptist Church (not specified)

11. A healthy community strengthens and expands the continuity of 1. Hold service providers and payees more responsible for follow-up care. affordable services available for those who do not meet the criteria for the three mental health target populations (e.g. time-out services, medications, case management, follow-up care).

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Housing Subcommittee Action Plan
Criteria 01. A mentally healthy community has supportive case management available upon request which would prevent housing loss, and access basic, emergency needs, such as emergency rental assistance, food, clothing, counseling, healthcare, shelter, utility assistance, down payment assistance, and transportation. Task Who? 1. Review availability of case managers and areas they address, including needs and gaps. Austin Tenants Council MHMR case management services Homeless Network housing group 2. Develop collaborative effort to meet needs and gaps MHMR/Austin basic needs council County/HHS MHMR basic needs council Legal Aid Advocacy Austin Tenants Council Legal Aid Advocacy Austin Tenants Council Legal Aid Advocacy Austin Tenants Council Legal Aid Advocacy Austin Tenants Council Neigborhood Housing and Community Development/Paul Hilgers Legal Aid Advocacy Austin Tenants Council Legal Aid Advocacy Austin Tenants Council Family groups Consumer Advocacy groups Legal Aid Advocacy Austin Tenants Council

3. Research and apply for grants to fund additional case managers. 02. A mentally healthy community observes housing laws and rights 1. Review current training programs available throughout the community. for those with mental illness and to integrate individuals with a mental illness into the larger community. 2. Develop training programs for noted gaps.

3. Identify and develop resources to provide training.

4. Review programs and modify.

03. A mentally healthy community has data-driven systems to 1. Convene group to discuss criteria, conceptualize and formulate an action plan. improve access to available housing options. 1. Develop a training package. 04. A mentally healthy community has training for all consumers, family members, and other stakeholders on local, state, and federal laws and responsibilities. 2. Train the trainer sessions

3. Monitor impact on consumer

4. Update training package as needed

05. A mentally healthy community has a comprehensive city-wide housing plan which incorporates the needs of special housing groups.

1. Examine existing housing plans with the goal of combining and modifying to achieve one Neigborhood Housing and Community comprehensive plan for the city. Development as lead Other key entities 2. Develop an action plan. Neigborhood Housing and Community Development as lead Other key entities Neigborhood Housing and Community Development as lead Other key entities

3. Implement

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Criteria 06. A mentally healthy community has mandatory training for housing providers, bankers, lenders, developers, and others on the housing needs and rights of individuals with mental disabilities. Task 1. Compile a list of housing providers. Who? Austin Tenants Council Home of Your Own Housing Authority of the City of Austin Austin Housing Finance Corporation Austin Housing Finance Corporation public information office Austin Tenants Council City of Austin Equal Employment Opportunity and Fair Housing Offices Texas Workforce Commission Civil Rights Division Texas Rio Grande Legal Council Housing Authority of the City of Austin/COA Housing Authority of the City of Austin Neigborhood Housing and Community Development Housing Authority of the City of Austin Neigborhood Housing and Community Development City of Austin Developers Housing Authority of the City of Austin Neigborhood Housing and Community Development Housing Authority of the City of Austin Neigborhood Housing and Community Development Housing Authority of the City of Austin Neigborhood Housing and Community Development Developers MHMR TMHC NAMI MHMR TMHC MHMR TMHC NAMI

2. Compile a list of trainers, curriculum and requirements. 3. Advertise training availability. 4. Provide training.

07. A mentally healthy community has sufficient, safe, affordable, accessible, and integrated housing units.

1. Inventory current housing. 2. Conduct needs assessment.

3. Analyze results of assessment (final report).

08. A mentally healthy community has a policy of inclusionary zoning, such as requiring builders to construct a percentage of affordable housing units in their developments or pay into the housing trust fund for affordable housing. (Inclusionary zoning may not be legal in the state of Texas. There will need to be further discussion and a definition created for inclusionary zoning before work begins on this criteria.)

4. Develop incentives to produce housing units. 5. Produce needed housing units. 1. Conduct needs assessment.

2. Analyze results of assessment (final report)

3. Develop policy

4. Build units or pay into housing trust fund. 09. A mentally healthy community treats all individuals with dignity 1. Train service housing service providers in sensitivity to individuals with mental disabilities. and respect. 2. Sensitivity training,

3. Awareness campaign to market the trainings,

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Criteria 10. A mentally healthy community has training on how to access funds to build, own, or modify housing and to access rental assistance. Task 1. Identify entities with experience in accessing funds to TDHCA, local housing authority, HOYO, Tenant Council, ADAPT, UCP. 2. Coordinate a training utilizing the above entities to provide information in these areas. 3. Provide training for free to individuals willing to commit to or mentor other individuals through the process of accessing the assistance. 4. Develop 3rd grade level written or on-line materials delineating steps and resources. Who? MHMR MHMR Diana McIver & Associates

Diana McIver & Associates Other consultants 11. A mentally healthy community has resources to hold people and 1. Assist individuals in knowing their rights and who to contact if they think their rights have Texas Workforce Commission Civil Rights providers accountable for violating fair housing and Americans with been violated; written information, on-line information and the number to call for clarification Division Disabilities Act (ADA). and referral. Austin Tenants Council Advocacy Inc. CRO MHMR Legal Aid City of Austin, Office of EE and Fair Housing

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Criteria Task 01. A mentally healthy community utilizes social clubs, professional 1. The City of Austin will convene a meeting to initiate the group process. organizations, support groups, neighborhood groups, and faith2. Create a planning committee of group representatives with expertise and commitment. based communities as vehicles for community mental health education. Who? Mayor’s Office Austin Tenants CouncilMHMR CAN AAHSA United Way AAIM Chambers PTA’s Emerge Consumer Organizations Neighborhood Councils Austin Tenants CouncilMHMR CAN AAHSA United Way AAIM Chambers PTA’s Emerge Consumer Organizations Neighborhood Councils Austin Tenants CouncilMHMR CAN AAHSA United Way AAIM Chambers PTA’s Emerge Consumer Organizations Neighborhood Councils Mayor Wynn Assn. of Health Professionals, educational reps, and list on #1 City, community leaders, policy makers, foundation reps, business leaders

3. Identify and prioritize target groups and issues.

4. Develop content, talking points and a video or Powerpoint/multi-media presentation.

02. A mentally healthy community has a broad-based, community- 1. The Mayor’s staff will assign a task person to facilitate and support the work of the Task Force. wide structure to carry on the work of the Mental Health Task Force’s education and awareness campaign. 2. Develop an open consortium that will become a permanent structure. 3. Secure funding for the on-going support of the consortium.

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Task 1. Establish linkages with umbrella groups such as Austin Interfaith and minority-oriented organizations and Chambers of Commerce. 2. Establish linkages with special population groups, including the underserved, e.g. the elderly, ethnic and racial minorities, and pre-school children. 3. Utilize CAN, academic community and the media to disseminate information about recovery and resiliency. 4. Coordinate with mental health advocacy groups in overall planning. 1. Develop the training curriculum based on best practices and tailored to the diverse target 04. A mentally healthy community provides evidence-based, culturally appropriate mental health training for those who work with groups. older adults, teens, substance abusers, people with co-occurring 2. Train front-line staff, receptionists, first responders, dispAustin Tenants Councilhers, disorders, and people with developmental disabilities. police, EMT’s, and ER staff in appropriate strategies for relating to persons with emotional disorders, mental illness and/or substance abuse issues. 05. A mentally healthy community reviews linguistically and culturally competent models of best practice programs in its own and other communities and works toward replication, including ongoing aggressive outreach to underserved populations. 1. Create definitions for linguistic and cultural competence. 2. Identify where these programs exist geographically and review program components. 3. Identify which programs are appropriate to use within the community by establishing an ad-hoc community group to review. 4. Determine linguistically and culturally competent measures of effectiveness (prior to replication and training). 5. Replicate selected programs and train appropriate providers around the issues, e.g. mental health providers, teachers, faith communities/clergy, health care providers. 6. Evaluate effectiveness of programs. 7. Using evaluation information, modify programming as necessary. Expand and replicate successful programs. 8. Repeat steps 3-7. Criteria 03. A mentally healthy community communicates with the public, the faith-based community, and the media about the treatability of mental illness and the high success rates of various treatment modalities in a linguistically, ethnically, and culturally appropriate manner. Who? Task Force, Consortium Task Force, Consortium Task Force, Consortium Task Force, Consortium Experts in MH, Consultants CAN, AMH, professional MH org’s, AAHSA

Jeff Patterson, Hogg Foundation Dr. King Davis or designee, Hogg Foundation Ad-hoc group convened by Monitoring committee Dr. King Davis, Hogg Foundation Mildred Vuris, MHMR as lead agency

Monitoring Committee and Hogg Foundation Local providers identified in #3

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Criteria 06. A mentally healthy community ensures that policymakers understand the positive fiscal impact of prevention and treatment. Who? CAN, MHMR, MHAT, CPPP, LBJ School, other educational institutions 2. Create educational and marketing materials that demonstrate fiscal impact. Public Affairs staff at Time Warner, CAN, Austin Tenants CouncilMHMR 3. Identify appropriate policy makers with whom to share information (e.g. city and county Austin Tenants CouncilMHMR – Gov’t Affairs, delegations, NAMI, state legislators, Chambers of Commerce Boards, Texas Psychological CAN Association). 4. Create strategies to provide policy makers and decision makers with appropriate information. 5. Identify and obtain commitment of people willing to make presentations and carry the message. 6. Implement strategies. 7. Evaluate effectiveness of strategies and if policies change (positively) as a result of marketing strategies. 8. Repeat steps 1-7, incorporating evaluation. 07. A mentally healthy community develops and implements an 1. Develop marketing committee that includes Time Warner, Laurie Alexander, Hogg effective mental and physical wellness communication plan targeted Foundation, UT School of Journalism, Davis Group and others. at the general public. 2. Develop media messages and comprehensive communications plan, including evaluation. 3. Identify appropriate media channels for getting message out (public access tv – city, educational channels, radio – Spanish speaking and KAZI, neighborhood associations, newscast stories, PSA’s). 4. Identify non-traditional communication channels such as public forums, neighborhood associations, access tv, faith-based groups, PTA’s etc. 5. Create PSA’s and specific TV-radio spots, and develop community media kits for presenters to ensure consistency of message. 6. Implement strategies. 7. Evaluate effectiveness of presentations and strategies and modify messages as appropriate. 8. Repeat steps 2-7. Public Affairs staff, Time Warner Austin Tenants CouncilMHMR, CAN, NAMI, MHAT, faith-based community & advocacy group reps Mayor’s staff, CAN, faith-based community reps Hogg Foundation, City staff, UT graduate students Monitoring committee Marketing committee Hogg Foundation, Marketing committee Task 1. Collect data reflecting the fiscal impact of prevention and treatment.

Marketing committee Marketing Committee Marketing committee Hogg Foundation

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Criteria 08. A mentally healthy community maintains a community suicide prevention plan that has the approval and support of the Mayor’s Office, the City Council, and the County Commissioners. Task 1. Create a community suicide prevention plan based on best practices. 2. Create educational and communication plan to support #1. 3. Seek endorsement and support of Monitoring Committee for suicide plan. Once secured, seek endorsement and support of Austin/Travis County Institutions (city, county, AISD, CAN, Chambers, MHMR, etc.) Who? Travis County Suicide Prevention Network/MHMR/AISD TCSPN, Marketing Committee TCSPN

4. Disseminate information to key target groups (schools, clergy, employers, MH providers, consumers, advocacy groups). 5. Implement suicide and communication plans. 6. Evaluate effectiveness of plan and modify as appropriate. (awareness and reduced suicide rate) 7. Repeat steps 1-6 incorporating evaluation results. 09. A mentally healthy community designates a staff member or 1. Mayor calls meeting of Chambers to ascertain organizational structure and present department at the Austin Chamber of Commerce that is responsible information. for educating employers about the continuum of mental health from 2. Meeting with all Chambers to share information on mental health, mental illness and health to illness in order to increase productivity and decrease effects on productivity and health care costs. health care services required. 3. Select staff member. 4. Staff person meets with organizations that have data and information.

TCSPN, Marketing Committee Media outlets, CAN MH planning group Hogg Foundation

Mayor Wynn Mayor, MHMR, Worksource, Hogg Foundation, CAN, Adult MH Planning Partnership Chambers Staff, MHMR, Worksource, Hogg Foundation, CAN, Adult MH Planning Partnership Staff/Hogg Foundation Staff Staff/Hogg Staff Chairs of Task Force MH Experts, Consultants MH Experts, Consultants Consultants Schools/public agencies MH Experts, Consultants Chairs of Task Force Consultant hired by school district Consultant Evaluation committee Consultant Schools

5. Staff formulates educational plan and evaluation plan. 6. Staff delivers/provides educational programs. 7. Evaluate program. 8. Present data to Mayor and Chambers with recommendations for continuation. 10. A mentally healthy community includes mental health education 1. Approach school districts and first responder organizations to obtain support. in primary, secondary, and post-secondary school curricula and to 2. Conduct focus groups of teachers, principals, police trainers, sheriff trainers, EMS first responders, including police and emergency medical trainers, Fire Dept. trainers to determine needs. technicians. 3. Develop curricula. 4. Provide training on curricula through series of workshops to schools and public agencies where first responders are trained. 5. Implement curricula. 6. Evaluate with recommendations for continuation. 1. Approach school district Board and obtain support. 11. A mentally healthy community ensures that schools teach students and teachers to value and appreciate individual differences 2. Conduct focus groups of parents, students, teachers, principals, counselors, PTA and lifestyle choices, including both mental and physical health representatives to determine needs. conditions. 3. Develop, obtain or modify existing curriculum that includes values, activities and evaluation tools. 4. Review, evaluate and approve curriculum. 5. Provide training on curriculum. 6. Implement curriculum.

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Criteria 12. A mentally healthy community creates a Partners in Education Program focused on mental health issues. Task 7. Evaluate with recommendations for continuation. 1. Meet with Partners in Education leadership to persuade them of the need to include mental health education as an annual goal of the organization. 2. Provide Partners in Education with appropriate educational materials, including speakers, to recruit sponsors for program. 3. Implement program in selected schools. 4. Evaluate program, modify as appropriate and make recommendations for continuation. Who? Consultant Chairs of Task Force or designees MHMR, CAN, MH provider groups Partners in Education Partners in Education

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